Left atrial appendage thrombus with severe mitral stenosis: Responders and non-responders to anticoagulation

Tariq Ashraf; Kanwal Fatima Aamir; Asif Nadeem; Shirjeel Murtaza; Parveen Akhtar; Samra Yasmin Haque; Rahmat Ghaffar; Mahmood Ul Hassan; Fateh Ali Tipoo

doi:10.1016/j.repc.2023.12.007

Left atrial appendage thrombus with severe mitral stenosis: Responders and non-responders to anticoagulation

Rev Port Cardiol. 2024 Feb 23:S0870-2551(24)00070-2. doi: 10.1016/j.repc.2023.12.007. Online ahead of print.

[Article in English, Portuguese]

Authors

Tariq Ashraf¹, Kanwal Fatima Aamir², Asif Nadeem³, Shirjeel Murtaza⁴, Parveen Akhtar², Samra Yasmin Haque⁴, Rahmat Ghaffar⁵, Mahmood Ul Hassan⁵, Fateh Ali Tipoo⁶

Affiliations

¹ Karachi Institute of Heart Diseases, Karachi, Pakistan. Electronic address: tariqash45@gmail.com.
² National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
³ Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan.
⁴ Punjab Institute of Cardiology, Lahore, Pakistan.
⁵ Hayatabad Medical Complex, Peshawar, Pakistan.
⁶ Aga Khan University Hospital, Karachi, Pakistan.

PMID: 38401704
DOI: 10.1016/j.repc.2023.12.007

Abstract

Introduction and objective: Mitral stenosis (MS) is one of the most frequently observed valvular heart lesions in developing countries and is due to different etiologies. The effects of anticoagulation in different types of left atrial appendage (LAA) are unknown. The current study aimed to determine the resolution of LAA thrombus on transesophageal echocardiography (TEE) after three months of optimal anticoagulation in patients with different types of LAA at baseline cardiac computed tomography of patients with severe MS.

Methods: This prospective cohort study observed the frequency of LAA thrombus resolution after three months of anticoagulation therapy in patients with severe MS. The response rate in different morphologies of LAA and locations was also assessed. Thrombus resolution after three months of warfarin therapy was assessed on repeat TEE.

Results: A total of 88 patients were included, mean age 37.95±11.87 years. Repeat TEE showed thrombus resolution in only 27.3% of patients. The rate of thrombus resolution was 8/12 (66.7%), 4/28 (14.3%), 8/36 (22.2%), and 4/12 (33.3%) for patients with cactus, cauliflower, chicken wing, and windsock LAA type, respectively. The resolution rate was 0/12 (0%), 4/44 (9.1%), and 20/32 (62.5%) for patients with thrombus in the base, body, and tip of the LAA, respectively.

Conclusion: The cactus type of LAA morphology and thrombus at the LAA tip responded well to three months of anticoagulation, however, patients with thrombus in the LAA base and body and cauliflower and chicken wing morphology were non-responders and could benefit from early referral for surgical management.

Keywords: Anticoagulation; Anticoagulação; Apêndice atrial esquerdo; Ecocardiografia transesofágica; Estenose mitral; Left atrial appendage; Mitral stenosis; Transesophageal echocardiography.