Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure

Luis Marroquin, Gabriela Tirado-Conte, Radosław Pracoń, Witold Streb, Hipolito Gutierrez, Giacomo Boccuzzi, Dabit Arzamendi-Aizpurua, Ignacio Cruz-González, Juan Miguel Ruiz-Nodar, Jung Sun Kim, Xavier Freixa, Jose Ramon Lopez-Minguez, Ole De Backer, Rafael Ruiz-Salmeron, Antonio Dominguez, Angela McInerney, Vicente Peral, Rodrigo Estevez-Loureiro, Eduard Fernandez-Nofrerias, Afonso B. Freitas-FerrazFrancesco Saia, Zenon Huczek, Livia Gheorghe, Pablo Salinas, Marcin Demkow, Jose R. Delgado-Arana, Estefania Fernandez Peregrina, Zbibniew Kalarus, Ana Elvira Laffond, Yangsoo Jang, Jose Carlos Fernandez Camacho, Oh Hyun Lee, Jose M. Hernández-Garcia, Caterina Mas-Llado, Berenice Caneiro Queija, Ignacio J. Amat-Santos, Maciej Dabrowski, Josep Rodés-Cabau, Luis Nombela Franco

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

Abstract

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 (~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.

Original languageEnglish
Pages (from-to)1098-1106
Number of pages9
JournalHeart
Volume108
Issue number14
DOIs
Publication statusPublished - 2022

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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