Songkwan Silaruks, MD; Bandit Thinkhamrop, PhD; Songsak Kiatchoosakun, MD; Chaiyasith Wongvipaporn, MD; Pyatat Tatsanavivat, MD
Silaruks S, Thinkhamrop B, Kiatchoosakun S, Wongvipaporn C, Tatsanavivat P. Resolution of Left Atrial Thrombus after 6 Months of Anticoagulation in Candidates for Percutaneous Transvenous Mitral Commissurotomy. Ann Intern Med. 2004;140:101-105. doi: 10.7326/0003-4819-140-2-200401200-00010
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Published: Ann Intern Med. 2004;140(2):101-105.
Resolution of left atrial thrombus after long-term oral anticoagulation enhances safe percutaneous transvenous mitral commissurotomy (PTMC); however, the short-term benefit has not been defined.
To estimate the resolution rate of left atrial thrombus among PTMC candidates after 6 months of oral anticoagulation and to determine its main predictors.
Community-based university medical center.
219 PTMC candidates with thrombus demonstrated by multiplane transesophageal echocardiographic studies.
The primary outcome was the status of the thrombus at the first 6-month follow-up; secondary measures were bleeding or thromboembolic complications.
Among 219 PTMC candidates with left atrial thrombus (mean age [Â±SD], 39.6â€‰Â±â€‰7.4 years [range, 19 to 62 years]), complete resolution of thrombus, with an overall disappearance rate of 24.2% (95% CI, 18.5% to 29.9%), was demonstrated in 53 patients who subsequently underwent successful PTMC. In another 166 patients, the thrombus size was reduced by 24% (Pâ€‰< 0.001). No thrombus resolution was observed in the 27 patients with a left atrial body thrombus. Eighteen patients had minor bleeding. The significant predictors of thrombus resolution were a New York Heart Association class of 2 or less, a left atrial appendage thrombus size of 1.6 cm2 or less, a left atrial spontaneous echocardiographic contrast grade of 1 or less, and an international normalized ratio (INR) of at least 2.5. Patients with all of these predictors had a 94.4% chance of complete thrombus resolution (CI, 84.4% to 98.1%).
After 6 months of oral anticoagulation, the left atrial thrombus disappeared in about a quarter of PTMC candidates so they could safely undergo PTMC. Less clinical severity, lower grading of the left atrial spontaneous echocardiographic contrast, a smaller thrombus, and a higher INR level predict thrombus resolution.
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Cardiology, Valvular Heart Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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