Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry

Agnieszka Kapłon-Cieślicka; Monika Gawałko; Monika Budnik; Beata Uziębło-Życzkowska; Paweł Krzesiński; Katarzyna Starzyk; Iwona Gorczyca-Głowacka; Ludmiła Daniłowicz-Szymanowicz; Damian Kaufmann; Maciej Wójcik; Robert Błaszczyk; Jarosław Hiczkiewicz; Katarzyna Łojewska; Katarzyna Mizia-Stec; Maciej T Wybraniec; Katarzyna Kosmalska; Marcin Fijałkowski; Anna Szymańska; Mirosław Dłużniewski; Maciej Haberka; Michał Kucio; Błażej Michalski; Karolina Kupczyńska; Anna Tomaszuk-Kazberuk; Katarzyna Wilk-Śledziewska; Renata Wachnicka-Truty; Marek Koziński; Paweł Burchardt; Piotr Scisło; Radosław Piątkowski; Janusz Kochanowski; Grzegorz Opolski; Marcin Grabowski

doi:10.3390/jcm11102705

Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry

Agnieszka Kapłon-Cieślicka, Monika Gawałko^*, Monika Budnik, Beata Uziębło-Życzkowska, Paweł Krzesiński, Katarzyna Starzyk, Iwona Gorczyca-Głowacka, Ludmiła Daniłowicz-Szymanowicz, Damian Kaufmann, Maciej Wójcik, Robert Błaszczyk, Jarosław Hiczkiewicz, Katarzyna Łojewska, Katarzyna Mizia-Stec, Maciej T Wybraniec, Katarzyna Kosmalska, Marcin Fijałkowski, Anna Szymańska, Mirosław Dłużniewski, Maciej HaberkaMichał Kucio, Błażej Michalski, Karolina Kupczyńska, Anna Tomaszuk-Kazberuk, Katarzyna Wilk-Śledziewska, Renata Wachnicka-Truty, Marek Koziński, Paweł Burchardt, Piotr Scisło, Radosław Piątkowski, Janusz Kochanowski, Grzegorz Opolski, Marcin Grabowski

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism. The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to oral anticoagulation (OAC).

METHODS: LATTEE (NCT03591627) was a multicenter, prospective, observational study enrolling consecutive patients with AF/AFl referred for transesophageal echocardiography before cardioversion or ablation.

RESULTS: Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had the worst renal function and were highest in both bleeding and thromboembolic risk, and more often received reduced doses. Prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p < 0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p < 0.01), even after propensity score weighting (13% vs. 7.5%; p < 0.01). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p < 0.01 for both comparisons), however, not after propensity score weighting.

CONCLUSIONS: The prevalence of LAT in AF is non-negligible even on chronic OAC. The risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs.

Original language	English
Article number	2705
Number of pages	13
Journal	Journal of Clinical Medicine
Volume	11
Issue number	10
DOIs	https://doi.org/10.3390/jcm11102705
Publication status	Published - 11 May 2022

Keywords

APPENDAGE CLOSURE
EFFICACY
METAANALYSIS
ORAL ANTICOAGULANTS
PREVENTION
SAFETY
STROKE
WARFARIN
apixaban
dabigatran
rivaroxaban
thromboembolic risk
transesophageal echocardiography

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Kapłon-Cieślicka, A., Gawałko, M., Budnik, M., Uziębło-Życzkowska, B., Krzesiński, P., Starzyk, K., Gorczyca-Głowacka, I., Daniłowicz-Szymanowicz, L., Kaufmann, D., Wójcik, M., Błaszczyk, R., Hiczkiewicz, J., Łojewska, K., Mizia-Stec, K., Wybraniec, M. T., Kosmalska, K., Fijałkowski, M., Szymańska, A., Dłużniewski, M., ... Grabowski, M. (2022). Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry. Journal of Clinical Medicine, 11(10), Article 2705. https://doi.org/10.3390/jcm11102705

@article{2dae3a72c03c44c695f300d275bc9ca2,

title = "Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry",

abstract = "BACKGROUND: Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism. The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to oral anticoagulation (OAC).METHODS: LATTEE (NCT03591627) was a multicenter, prospective, observational study enrolling consecutive patients with AF/AFl referred for transesophageal echocardiography before cardioversion or ablation.RESULTS: Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had the worst renal function and were highest in both bleeding and thromboembolic risk, and more often received reduced doses. Prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p < 0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p < 0.01), even after propensity score weighting (13% vs. 7.5%; p < 0.01). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p < 0.01 for both comparisons), however, not after propensity score weighting.CONCLUSIONS: The prevalence of LAT in AF is non-negligible even on chronic OAC. The risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs.",

keywords = "APPENDAGE CLOSURE, EFFICACY, METAANALYSIS, ORAL ANTICOAGULANTS, PREVENTION, SAFETY, STROKE, WARFARIN, apixaban, dabigatran, rivaroxaban, thromboembolic risk, transesophageal echocardiography",

author = "Agnieszka Kap{\l}on-Cie{\'s}licka and Monika Gawa{\l}ko and Monika Budnik and Beata Uzi{\c e}b{\l}o-{\.Z}yczkowska and Pawe{\l} Krzesi{\'n}ski and Katarzyna Starzyk and Iwona Gorczyca-G{\l}owacka and Ludmi{\l}a Dani{\l}owicz-Szymanowicz and Damian Kaufmann and Maciej W{\'o}jcik and Robert B{\l}aszczyk and Jaros{\l}aw Hiczkiewicz and Katarzyna {\L}ojewska and Katarzyna Mizia-Stec and Wybraniec, {Maciej T} and Katarzyna Kosmalska and Marcin Fija{\l}kowski and Anna Szyma{\'n}ska and Miros{\l}aw D{\l}u{\.z}niewski and Maciej Haberka and Micha{\l} Kucio and B{\l}a{\.z}ej Michalski and Karolina Kupczy{\'n}ska and Anna Tomaszuk-Kazberuk and Katarzyna Wilk-{\'S}ledziewska and Renata Wachnicka-Truty and Marek Kozi{\'n}ski and Pawe{\l} Burchardt and Piotr Scis{\l}o and Rados{\l}aw Pi{\c a}tkowski and Janusz Kochanowski and Grzegorz Opolski and Marcin Grabowski",

note = "Publisher Copyright: {\textcopyright} 2022 by the authors. Licensee MDPI, Basel, Switzerland.",

year = "2022",

month = may,

day = "11",

doi = "10.3390/jcm11102705",

language = "English",

volume = "11",

journal = "Journal of Clinical Medicine",

issn = "2077-0383",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "10",

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Kapłon-Cieślicka, A, Gawałko, M, Budnik, M, Uziębło-Życzkowska, B, Krzesiński, P, Starzyk, K, Gorczyca-Głowacka, I, Daniłowicz-Szymanowicz, L, Kaufmann, D, Wójcik, M, Błaszczyk, R, Hiczkiewicz, J, Łojewska, K, Mizia-Stec, K, Wybraniec, MT, Kosmalska, K, Fijałkowski, M, Szymańska, A, Dłużniewski, M, Haberka, M, Kucio, M, Michalski, B, Kupczyńska, K, Tomaszuk-Kazberuk, A, Wilk-Śledziewska, K, Wachnicka-Truty, R, Koziński, M, Burchardt, P, Scisło, P, Piątkowski, R, Kochanowski, J, Opolski, G & Grabowski, M 2022, 'Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry', Journal of Clinical Medicine, vol. 11, no. 10, 2705. https://doi.org/10.3390/jcm11102705

TY - JOUR

T1 - Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy

T2 - LATTEE Registry

AU - Kapłon-Cieślicka, Agnieszka

AU - Gawałko, Monika

AU - Budnik, Monika

AU - Uziębło-Życzkowska, Beata

AU - Krzesiński, Paweł

AU - Starzyk, Katarzyna

AU - Gorczyca-Głowacka, Iwona

AU - Daniłowicz-Szymanowicz, Ludmiła

AU - Kaufmann, Damian

AU - Wójcik, Maciej

AU - Błaszczyk, Robert

AU - Hiczkiewicz, Jarosław

AU - Łojewska, Katarzyna

AU - Mizia-Stec, Katarzyna

AU - Wybraniec, Maciej T

AU - Kosmalska, Katarzyna

AU - Fijałkowski, Marcin

AU - Szymańska, Anna

AU - Dłużniewski, Mirosław

AU - Haberka, Maciej

AU - Kucio, Michał

AU - Michalski, Błażej

AU - Kupczyńska, Karolina

AU - Tomaszuk-Kazberuk, Anna

AU - Wilk-Śledziewska, Katarzyna

AU - Wachnicka-Truty, Renata

AU - Koziński, Marek

AU - Burchardt, Paweł

AU - Scisło, Piotr

AU - Piątkowski, Radosław

AU - Kochanowski, Janusz

AU - Opolski, Grzegorz

AU - Grabowski, Marcin

PY - 2022/5/11

Y1 - 2022/5/11

N2 - BACKGROUND: Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism. The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to oral anticoagulation (OAC).METHODS: LATTEE (NCT03591627) was a multicenter, prospective, observational study enrolling consecutive patients with AF/AFl referred for transesophageal echocardiography before cardioversion or ablation.RESULTS: Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had the worst renal function and were highest in both bleeding and thromboembolic risk, and more often received reduced doses. Prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p < 0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p < 0.01), even after propensity score weighting (13% vs. 7.5%; p < 0.01). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p < 0.01 for both comparisons), however, not after propensity score weighting.CONCLUSIONS: The prevalence of LAT in AF is non-negligible even on chronic OAC. The risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs.

AB - BACKGROUND: Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism. The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to oral anticoagulation (OAC).METHODS: LATTEE (NCT03591627) was a multicenter, prospective, observational study enrolling consecutive patients with AF/AFl referred for transesophageal echocardiography before cardioversion or ablation.RESULTS: Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had the worst renal function and were highest in both bleeding and thromboembolic risk, and more often received reduced doses. Prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p < 0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p < 0.01), even after propensity score weighting (13% vs. 7.5%; p < 0.01). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p < 0.01 for both comparisons), however, not after propensity score weighting.CONCLUSIONS: The prevalence of LAT in AF is non-negligible even on chronic OAC. The risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs.

KW - APPENDAGE CLOSURE

KW - EFFICACY

KW - METAANALYSIS

KW - ORAL ANTICOAGULANTS

KW - PREVENTION

KW - SAFETY

KW - STROKE

KW - WARFARIN

KW - apixaban

KW - dabigatran

KW - rivaroxaban

KW - thromboembolic risk

KW - transesophageal echocardiography

U2 - 10.3390/jcm11102705

DO - 10.3390/jcm11102705

M3 - Article

C2 - 35628832

SN - 2077-0383

VL - 11

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

IS - 10

M1 - 2705

ER -