The following is a summary of “Incidence and predictors of left atrial thrombus in patients with atrial fibrillation under anticoagulation therapy,” published in the March 2024 issue of Cardiology by Lee et al.
Left atrial thrombus (LAT) formation correlates with an increased risk of thromboembolic events.
Researchers conducted a retrospective study to examine LAT’s occurrence and determining factors in atrial fibrillation (AF) patients under anticoagulation therapy for over 4 weeks, crafting a predictive model based on clinical and echocardiographic parameters.
They assessed the medical records of 1,122 AF patients (mean age: 59.4 ± 11.0 years, 58.3% male) who had been undergoing anticoagulation treatment for more than 4 weeks and underwent transesophageal echocardiography (TEE). The primary endpoint was the identification of LAT via TEE.
The result showed that Warfarin and non-vitamin K oral anticoagulants were used in 74.4% and 25.6% of the patients at the time of examination. LAT was present in 60 patients (5.3%). The presence of LAT on TEE was associated with age ≥ 75 years (odds ratio [OR] 2.13 [95% confidence interval, 0.94–4.58]), persistent/permanent AF (OR 2.61 [1.42–4.93]), CHA2DS2-VASc score ≥ 3 points (OR 1.91 [1.05–3.48]), left ventricular ejection fraction < 40% (OR 2.35 [1.07–4.81]), and severe left atrial enlargement (OR 3.52 [1.89–6.79]). Moderate-to-severe mitral regurgitation was associated with a lower risk of LAT (OR 0.13 [0.04–0.34]). A scoring system comprising the predictors above showed excellent discrimination performance (area under the curve 0.791 [95% CI, 0.727–0.854]).
Investigators concluded that despite anticoagulation, many patients still have left atrial clots, suggesting a need for better identification before procedures using combined clinical and echocardiographic assessments.
Source: link.springer.com/article/10.1007/s00392-024-02422-5