TY - JOUR

T1 - Device-Related Thrombus after Left Atrial Appendage Closure

T2 - Data on Thrombus Characteristics, Treatment Strategies, and Clinical Outcomes from the EUROC-DRT-Registry

AU - Sedaghat, Alexander

AU - Vij, Vivian

AU - Al-Kassou, Baravan

AU - Gloekler, Steffen

AU - Galea, Roberto

AU - Fürholz, Monika

AU - Meier, Bernhard

AU - Valgimigli, Marco

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 - Søndergaard, Lars

AU - Nombela-Franco, Luis

AU - McInerney, Angela

AU - Korsholm, Kaspar

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 - Rycerz, Szymon

AU - Ognerubov, Dmitrii

AU - Merkulov, Evgeny

AU - Cruz-González, Ignacio

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

N1 - Publisher Copyright: © 2021 American Heart Association, Inc.

PY - 2021

Y1 - 2021

N2 - Background: Left atrial appendage closure is an established therapy in patients with atrial fibrillation. Although device-related thrombosis (DRT) is relatively rare, it is potentially linked to adverse events. As data on DRT characteristics, outcome, and treatment regimen are scarce, we aimed to assess these questions in a multicenter approach. Methods: One hundred fifty-six patients with the diagnosis of DRT after left atrial appendage closure were included in the multinational EUROC-DRT registry. Baseline characteristics included clinical and echocardiographic data. After inclusion, all patients underwent further clinical and echocardiographic follow-up to assess DRT dynamics, treatment success, and outcome. Results: DRT was detected after a median of 93 days (interquartile range, 54-161 days) with 17.9% being detected >6 months after left atrial appendage closure. Patients with DRT were at high ischemic and bleeding risk (CHA2DS2-VASc 4.5±1.7, HAS-BLED 3.3±1.2) and had nonparoxysmal atrial fibrillation (67.3%), previous stroke (53.8%), and spontaneous echo contrast (50.6%). The initial treatment regimens showed comparable resolution rates (antiplatelet monotherapy: 57.1%, dual antiplatelet therapy: 85.7%, vitamin K antagonists: 80.0%, novel oral anticoagulants: 75.0%, and heparin: 68.6%). After intensification or switch of treatment, complete DRT resolution was achieved in 79.5% of patients. Two-year follow-up revealed a high risk of mortality (20.0%) and ischemic stroke (13.8%) in patients with DRT. Patients with incomplete DRT resolution showed numerically higher stroke rates and increased mortality rates (stroke: 17.6% versus 12.3%, P=0.29; mortality: 31.3% versus 13.1%, P=0.05). Conclusions: A substantial proportion of DRT is detected >6 months after left atrial appendage closure, highlighting the need for imaging follow-up. Patients with DRT appear to be at a high risk for stroke and mortality. While DRT resolution was achieved in most patients, incomplete DRT resolution appeared to identify patients at even higher risk. Optimal DRT diagnostic criteria and treatment regimens are warranted.

AB - Background: Left atrial appendage closure is an established therapy in patients with atrial fibrillation. Although device-related thrombosis (DRT) is relatively rare, it is potentially linked to adverse events. As data on DRT characteristics, outcome, and treatment regimen are scarce, we aimed to assess these questions in a multicenter approach. Methods: One hundred fifty-six patients with the diagnosis of DRT after left atrial appendage closure were included in the multinational EUROC-DRT registry. Baseline characteristics included clinical and echocardiographic data. After inclusion, all patients underwent further clinical and echocardiographic follow-up to assess DRT dynamics, treatment success, and outcome. Results: DRT was detected after a median of 93 days (interquartile range, 54-161 days) with 17.9% being detected >6 months after left atrial appendage closure. Patients with DRT were at high ischemic and bleeding risk (CHA2DS2-VASc 4.5±1.7, HAS-BLED 3.3±1.2) and had nonparoxysmal atrial fibrillation (67.3%), previous stroke (53.8%), and spontaneous echo contrast (50.6%). The initial treatment regimens showed comparable resolution rates (antiplatelet monotherapy: 57.1%, dual antiplatelet therapy: 85.7%, vitamin K antagonists: 80.0%, novel oral anticoagulants: 75.0%, and heparin: 68.6%). After intensification or switch of treatment, complete DRT resolution was achieved in 79.5% of patients. Two-year follow-up revealed a high risk of mortality (20.0%) and ischemic stroke (13.8%) in patients with DRT. Patients with incomplete DRT resolution showed numerically higher stroke rates and increased mortality rates (stroke: 17.6% versus 12.3%, P=0.29; mortality: 31.3% versus 13.1%, P=0.05). Conclusions: A substantial proportion of DRT is detected >6 months after left atrial appendage closure, highlighting the need for imaging follow-up. Patients with DRT appear to be at a high risk for stroke and mortality. While DRT resolution was achieved in most patients, incomplete DRT resolution appeared to identify patients at even higher risk. Optimal DRT diagnostic criteria and treatment regimens are warranted.

KW - atrial appendage

KW - atrial fibrillation

KW - echocardiography

KW - heparin

KW - thrombosis

U2 - 10.1161/CIRCINTERVENTIONS.120.010195

DO - 10.1161/CIRCINTERVENTIONS.120.010195

M3 - Journal article

C2 - 34003661

AN - SCOPUS:85106170484

VL - 14

SP - 544

EP - 553

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

SN - 1941-7640

IS - 5

M1 - e010195

ER -