BACKGROUND: Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry. METHODS: We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics. RESULTS: Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5% vs. 81.5%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1% vs. 16.7%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5% vs. 3.8%, Hazard Ratio: 4.21 [95%-confidence interval: 1.88-9.49], p < 0.01). CONCLUSIONS: DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.
BACKGROUND: Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry. METHODS: We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics. RESULTS: Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5% vs. 81.5%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1% vs. 16.7%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5% vs. 3.8%, Hazard Ratio: 4.21 [95%-confidence interval: 1.88-9.49], p < 0.01). CONCLUSIONS: DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.
Authors: Xavier Freixa; Pedro Cepas-Guillen; Eduardo Flores-Umanzor; Ander Regueiro; Laura Sanchis; Andrea Fernandez-Valledor; Salvatore Brugaletta; Maria José Carretero; Barbara Vidal; Mónica Masotti; Victoria Martin-Yuste; Mercè Roqué; Marta Sitges; Manel Sabaté Journal: EuroIntervention Date: 2021-02-05 Impact factor: 6.534
Authors: Adel Aminian; Boris Schmidt; Patrizio Mazzone; Sergio Berti; Sven Fischer; Matteo Montorfano; Simon Cheung Chi Lam; Juha Lund; Federico M Asch; Ryan Gage; Ignacio Cruz-Gonzalez; Heyder Omran; Giuseppe Tarantini; Jens Erik Nielsen-Kudsk Journal: JACC Cardiovasc Interv Date: 2019-05-15 Impact factor: 11.195
Authors: Srinivas R Dukkipati; Saibal Kar; David R Holmes; Shephal K Doshi; Vijendra Swarup; Douglas N Gibson; Brijeshwar Maini; Nicole T Gordon; Michael L Main; Vivek Y Reddy Journal: Circulation Date: 2018-08-28 Impact factor: 29.690
Authors: Alexander Sedaghat; Jan-Wilko Schrickel; René Andrié; Robert Schueler; Georg Nickenig; Christoph Hammerstingl Journal: JACC Clin Electrophysiol Date: 2016-07-27
Authors: David R Holmes; Vivek Y Reddy; Zoltan G Turi; Shephal K Doshi; Horst Sievert; Maurice Buchbinder; Christopher M Mullin; Peter Sick Journal: Lancet Date: 2009-08-15 Impact factor: 79.321