Left Atrial Appendage Thrombi Formation in Japanese Non-Valvular Atrial Fibrillation Patients During Anticoagulation Therapy　― Warfarin vs. Direct Oral Anticoagulants

• Published in: Circulation Journal Vol. 81; no. 5; pp. 645 - 651
• Main Authors: Kawabata, Mihoko, Sasaki, Takeshi, Maeda, Shingo, Yoshitake, Takakatsu, Shiohira, Shinya, Nishimura, Takuro, Goya, Masahiko, Shirai, Yasuhiro, Isobe, Mitsuaki, Hirao, Kenzo
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2017
• Subjects: Aged; Anticoagulants - therapeutic use; Asian People; Atrial Appendage - pathology; Atrial Appendage - physiopathology; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Direct oral anticoagulant; Echocardiography, Transesophageal; Female; Heart Diseases - complications; Heart Diseases - drug therapy; Heart Diseases - etiology; Humans; Incidence; Left atrial appendage thrombus; Male; Middle Aged; Retrospective Studies; Thrombosis - etiology; Transesophageal echocardiography; Warfarin; Warfarin - therapeutic use; Left atrial appendage thrombus; Transesophageal echocardiography; Warfarin; Direct oral anticoagulant; Atrial fibrillation
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-16-1089

Background:Atrial fibrillation (AF) is a common cardiac arrhythmia, associated with increased cardiovascular morbidity and mortality including thromboembolic events. The aims of this study were to assess the prevalence of left atrial appendage (LAA) thrombi in Japanese non-valvular atrial fibrillation (NVAF) patients undergoing preprocedural transesophageal echocardiography (TEE) during anticoagulation therapy, and to compare the efficacy of warfarin and direct oral anticoagulants (DOAC).Methods and Results:This retrospective study reviewed records of 559 consecutive NVAF patients (445 men; age, 62±11 years) undergoing preprocedural TEE following at least 3 weeks of anticoagulation therapy. Of these, 275 patients had non-paroxysmal AF (49%). LAA thrombus was observed in 15 patients (2.7%). The prevalence of LAA thrombi was similar between the DOAC group (2.6%) and the warfarin group (2.8%, P=0.86). No patients with CHA2DS2-VASc score=0, or paroxysmal AF without prior stroke or transient ischemic attack, had LAA thrombi. On univariate analysis, non-paroxysmal AF, structural heart disease, antiplatelet therapy, larger left atrium, higher brain natriuretic peptide (BNP), reduced LAA flow, and higher CHA2DS2-VASc score were all associated with LAA thrombi. On multivariate analysis, BNP ≥173 pg/mL remained the only independent predictor of LAA thrombi.Conclusions:LAA thrombi were found in 2.7% of Japanese NVAF patients scheduled for procedures despite ongoing oral anticoagulation therapy. Incidence of thrombi was similar for patients on DOAC and on warfarin.