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Symptomatic vs. non-symptomatic device-related thrombus after LAAC: a sub-analysis from the multicenter EUROC-DRT registry

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

DOI

  • Vivian Vij, University of Bonn
    • ,
  • Ignacio Cruz-González, Hospital Clínico Universitario de Salamanca
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  • Roberto Galea, University of Bern
    • ,
  • Kerstin Piayda, CardioVasculäres Centrum
    • ,
  • Dominik Nelles, University of Bonn
    • ,
  • Lara Vogt, University of Bonn
    • ,
  • Steffen Gloekler, University of Bern
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  • Monika Fürholz, University of Bern
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  • Bernhard Meier, University of Bern
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  • Lorenz Räber, University of Bern
    • ,
  • Gilles O'Hara, Université Laval
    • ,
  • Dabit Arzamendi, Hospital of Santa Creu i Sant Pau
    • ,
  • Victor Agudelo, Hospital of Santa Creu i Sant Pau
    • ,
  • Lluis Asmarats, Université Laval
    • ,
  • Xavier Freixa, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
    • ,
  • Eduardo Flores-Umanzor, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain; Multidisciplinary Sleep Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
    • ,
  • Ole De Backer
    • ,
  • Lars Sondergaard
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  • Luis Nombela-Franco, Hospital Clínico San Carlos de Madrid
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  • Angela McInerney, Hospital Clínico San Carlos de Madrid
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  • Pablo Salinas, Hospital Clínico San Carlos de Madrid
    • ,
  • Kasper Korsholm
  • Jens Erik Nielsen-Kudsk
  • Shazia Afzal, Heinrich Heine University Düsseldorf
    • ,
  • Tobias Zeus, Heinrich Heine University Düsseldorf
    • ,
  • Felix Operhalski, Agaplesion Bethanien Krankenhaus
    • ,
  • Boris Schmidt, Agaplesion Bethanien Krankenhaus
    • ,
  • Gilles Montalescot, Université Paris Cité (Paris V, Paris VII)
    • ,
  • Paul Guedeney, Université Paris Cité (Paris V, Paris VII)
    • ,
  • Xavier Iriart, Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France.
    • ,
  • Noelie Miton, Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France.
    • ,
  • Jacqueline Saw, Vancouver General Hospital
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  • Thomas Gilhofer, University of Zurich
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  • Laurent Fauchier, Université de Tours
    • ,
  • Egzon Veliqi, Asklepios St. Georg Hospital, Hermann-Holthusen Institute for Radiotherapy, Hamburg, Germany.
    • ,
  • Felix Meincke, Asklepios St. Georg Hospital, Hermann-Holthusen Institute for Radiotherapy, Hamburg, Germany.
    • ,
  • Nils Petri, University of Würzburg
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  • Peter Nordbeck, University of Würzburg
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  • Rocio Gonzalez-Ferreiro, Hospital Clínico Universitario de Salamanca
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  • Deepak L Bhatt, Mount Sinai Hospital
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  • Alessandra Laricchia, Humanitas University
    • ,
  • Antonio Mangieri, Humanitas University
    • ,
  • Heyder Omran, Marienkrankenhaus
    • ,
  • Jan Wilko Schrickel, University of Bonn
    • ,
  • Josep Rodes-Cabau, Université Laval
    • ,
  • Georg Nickenig, University of Bonn
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  • Horst Sievert, CardioVasculäres Centrum
    • ,
  • Alexander Sedaghat, University of Bonn

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.

OriginalsprogEngelsk
TidsskriftClinical Research in Cardiology
ISSN1861-0684
DOI
StatusE-pub ahead of print - 9 jun. 2023

Bibliografisk note

© 2023. The Author(s).

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