TY - JOUR

T1 - Symptomatic vs. non-symptomatic device-related thrombus after LAAC

T2 - a sub-analysis from the multicenter EUROC-DRT registry

AU - Vij, Vivian

AU - Cruz-González, Ignacio

AU - Galea, Roberto

AU - Piayda, Kerstin

AU - Nelles, Dominik

AU - Vogt, Lara

AU - Gloekler, Steffen

AU - Fürholz, Monika

AU - Meier, Bernhard

AU - Räber, Lorenz

AU - O’Hara, Gilles

AU - Arzamendi, Dabit

AU - Agudelo, Victor

AU - Asmarats, Lluis

AU - Freixa, Xavier

AU - Flores-Umanzor, Eduardo

AU - De Backer, Ole

AU - Sondergaard, Lars

AU - Nombela-Franco, Luis

AU - McInerney, Angela

AU - Salinas, Pablo

AU - Korsholm, Kasper

AU - Nielsen-Kudsk, Jens Erik

AU - Afzal, Shazia

AU - Zeus, Tobias

AU - Operhalski, Felix

AU - Schmidt, Boris

AU - Montalescot, Gilles

AU - Guedeney, Paul

AU - Iriart, Xavier

AU - Miton, Noelie

AU - Saw, Jacqueline

AU - Gilhofer, Thomas

AU - Fauchier, Laurent

AU - Veliqi, Egzon

AU - Meincke, Felix

AU - Petri, Nils

AU - Nordbeck, Peter

AU - Gonzalez-Ferreiro, Rocio

AU - Bhatt, Deepak L.

AU - Laricchia, Alessandra

AU - Mangieri, Antonio

AU - Omran, Heyder

AU - Schrickel, Jan Wilko

AU - Rodes-Cabau, Josep

AU - Nickenig, Georg

AU - Sievert, Horst

AU - Sedaghat, Alexander

N1 - Publisher Copyright: © 2023, The Author(s).

PY - 2023

Y1 - 2023

N2 - Background: Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is associated with adverse outcomes, i.e. ischemic stroke or systemic embolism (SE). Data on predictors of stroke/SE in the context of DRT are limited. Aims: This study aimed to identify predisposing factors for stroke/SE in DRT patients. In addition, the temporal connection of stroke/SE to DRT diagnosis was analyzed. Methods: The EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared. Results: Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR 37–558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0 ± 9.1% vs. 54.2 ± 11.0%, p = 0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p = 0.06). Other baseline parameters and device positions were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%). Conclusion: Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Identification of risk factors remains cumbersome, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events. Graphical Abstract: [Figure not available: see fulltext.]

AB - Background: Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is associated with adverse outcomes, i.e. ischemic stroke or systemic embolism (SE). Data on predictors of stroke/SE in the context of DRT are limited. Aims: This study aimed to identify predisposing factors for stroke/SE in DRT patients. In addition, the temporal connection of stroke/SE to DRT diagnosis was analyzed. Methods: The EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared. Results: Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR 37–558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0 ± 9.1% vs. 54.2 ± 11.0%, p = 0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p = 0.06). Other baseline parameters and device positions were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%). Conclusion: Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Identification of risk factors remains cumbersome, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events. Graphical Abstract: [Figure not available: see fulltext.]

KW - Atrial fibrillation

KW - Device-related thrombus

KW - Left atrial appendage closure

KW - Stroke

U2 - 10.1007/s00392-023-02237-w

DO - 10.1007/s00392-023-02237-w

M3 - Journal article

C2 - 37294311

AN - SCOPUS:85161413134

VL - 112

SP - 1790

EP - 1799

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

SN - 1861-0684

ER -