Left Atrial Appendage Thrombus Prior to Atrial Fibrillation Ablation in the Era of Direct Oral Anticoagulants
-
- Harada Masahide
- Department of Cardiology, Fujita Health University
-
- Koshikawa Masayuki
- Department of Cardiology, Fujita Health University
-
- Motoike Yuji
- Department of Cardiology, Fujita Health University
-
- Ichikawa Tomohide
- Department of Cardiology, Fujita Health University
-
- Sugimoto Kunihiko
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University Hospital
-
- Watanabe Eiichi
- Department of Cardiology, Fujita Health University
-
- Ozaki Yukio
- Department of Cardiology, Fujita Health University
この論文をさがす
抄録
<p>Background: In atrial fibrillation (AF) patients, the effect of direct oral anticoagulant (DOACs) therapy on the incidence of left atrial appendage thrombus (LAT) remains poorly investigated. This study examined the prevalence and risk factors of LAT in AF patients on DOACs undergoing catheter ablation, and sought an anticoagulation strategy for LAT. </p><p>Methods and Results: In 407 AF patients on DOACs, transesophageal echocardiography (TEE) was performed 1 day before ablation. If patients had LAT, initial DOACs were switched to dabigatran (300 mg) or warfarin based on their renal function; TEE was repeated after treatment for ≥4 weeks. LAT was detected in 18 patients (4.4%). The prevalence of persistent AF and low-dose treatment/inappropriate dose reduction of DOACs, CHADS2/CHA2DS2-VASc scores, serum N-terminal pro-brain natriuretic peptide levels, and LA dimension/LA volume index significantly increased in patients with LAT vs. those without LAT. AF rhythm on TEE and spontaneous echo contrast also increased in patients with LAT; LA appendage flow velocity decreased. In the multivariate analysis, persistent AF and inappropriately reduced DOAC dose were risk factors for LAT. On repeat TEE, LAT had disappeared in 13 of 16 patients treated with dabigatran and in 2 of 2 patients treated with warfarin. </p><p>Conclusions: DOACs still carry a finite risk of LAT in AF patients. Inappropriately reduced DOAC dose should be avoided to minimize the thromboembolic risk. Regular-dose dabigatran may have therapeutic efficacy against LAT. </p>
収録刊行物
-
- Circulation Journal
-
Circulation Journal 82 (11), 2715-2721, 2018-10-25
一般社団法人 日本循環器学会
- Tweet
キーワード
詳細情報 詳細情報について
-
- CRID
- 1390282763060656768
-
- NII論文ID
- 40021697183
-
- NII書誌ID
- AA11591968
-
- ISSN
- 13474820
- 13469843
-
- NDL書誌ID
- 029294239
-
- PubMed
- 30101809
-
- 本文言語コード
- en
-
- データソース種別
-
- JaLC
- NDL
- Crossref
- PubMed
- CiNii Articles
- KAKEN
-
- 抄録ライセンスフラグ
- 使用不可