RT Journal Article
T1 Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure
A1 Marroquin, Luis
A1 Tirado-Conte, Gabriela
A1 Praco, Radoslaw
A1 Streb, Witold
A1 Gutierrez, Hipolito
A1 Boccuzzi, Giacomo
A1 Arzamendi-Aizpurua, Dabit
A1 Cruz-Gonzalez, Ignacio
A1 Ruiz-Nodar, Juan Miguel
A1 Kim, Jung-Sun
A1 Freixa, Xavier
A1 Lopez-Minguez, Jose Ramon
A1 De Backer, Ole
A1 Ruiz-Salmeron, Rafael
A1 Dominguez, Antonio
A1 McInerney, Angela
A1 Peral, Vicente
A1 Estevez-Loureiro, Rodrigo
A1 Fernandez-Nofrerias, Eduard
A1 Freitas-Ferraz, Afonso B.
A1 Saia, Francesco
A1 Huczek, Zenon
A1 Gheorghe, Livia
A1 Salinas, Pablo
A1 Demkow, Marcin
A1 Delgado-Arana, Jose R.
A1 Peregrina, Estefania Fernandez
A1 Kalarus, Zbibniew
A1 Laffond, Ana Elvira
A1 Jang, Yangsoo
A1 Camacho, Jose Carlos Fernandez
A1 Lee, Oh-Hyun
A1 Hernandez-Garcia, Jose M.
A1 Mas-Llado, Caterina
A1 Queija, Berenice Caneiro
A1 Amat-Santos, Ignacio J.
A1 Dabrowski, Maciej
A1 Rodes-Cabau, Josep
A1 Franco, Luis Nombela
K1 Fibrillation
K1 Stroke
K1 Occlusion
K1 Risk
K1 Morphology
K1 Warfarin
K1 Feasibility
K1 Prevention
K1 Device
AB Objective Left atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus.Methods This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively.Results IAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102).Conclusion In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (similar to 10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up.
PB Bmj publishing group
SN 1355-6037
YR 2021
FD 2021-10-21
LK https://hdl.handle.net/10668/25298
UL https://hdl.handle.net/10668/25298
LA en
DS RISalud
RD Apr 19, 2025