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Resolution of Left Atrial Thrombus after 6 Months of Anticoagulation in Candidates for Percutaneous Transvenous Mitral Commissurotomy

Songkwan Silaruks, MD; Bandit Thinkhamrop, PhD; Songsak Kiatchoosakun, MD; Chaiyasith Wongvipaporn, MD; and Pyatat Tatsanavivat, MD
[+] Article and Author Information

From Khon Kaen University, Khon Kaen, Thailand.


Acknowledgments: The authors thank Bryan Roderick Hamman for his assistance with the English-language presentation of the manuscript. They also thank the patients for their participation and the colleagues, nurses, and hospital staff who cared for the PTMC patients and the many doctors who referred patients to them.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Songkwan Silaruks, MD, Department of Medicine, Faculty of Medicine, Khon Kaen University, Mitraparp Road, Khon Kaen 40002, Thailand; e-mail, sonsil@kku.ac.th.

Current Author Addresses: Drs. Silaruks, Kiatchoosakun, Wongvipaporn, and Tatsanavivat: Department of Medicine, Faculty of Medicine, Khon Kaen University, Mitraparp Road, Khon Kaen 40002, Thailand.

Dr. Thinkhamrop: Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Mitraparp Road, Khon Kaen 40002, Thailand.

Author Contributions: Conception and design: S. Silaruks.

Analysis and interpretation of the data: S. Silaruks, B. Thinkhamrop.

Drafting of the article: S. Silaruks, B. Thinkhamrop.

Critical revision of the article for important intellectual content: S. Silaruks, B. Thinkhamrop, S. Kiatchoosakun, C. Wongvipaporn, P. Tatsanavivat.

Final approval of the article: S. Silaruks, B. Thinkhamrop, S. Kiatchoosakun, C. Wongvipaporn, P. Tatsanavivat.

Provision of study materials or patients: S. Silaruks, S. Kiatchoosakun, C. Wongvipaporn, P. Tatsanavivat.

Statistical expertise: B. Thinkhamrop.

Collection and assembly of data: S. Silaruks, S. Kiatchoosakun, C. Wongvipaporn, P. Tatsanavivat.


Ann Intern Med. 2004;140(2):101-105. doi:10.7326/0003-4819-140-2-200401200-00010
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Background: 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.

Objectives: To estimate the resolution rate of left atrial thrombus among PTMC candidates after 6 months of oral anticoagulation and to determine its main predictors.

Design: Prospective cohort.

Setting: Community-based university medical center.

Patients: 219 PTMC candidates with thrombus demonstrated by multiplane transesophageal echocardiographic studies.

Measurements: The primary outcome was the status of the thrombus at the first 6-month follow-up; secondary measures were bleeding or thromboembolic complications.

Results: Among 219 PTMC candidates with left atrial thrombus (mean age [±SD], 39.6 ± 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% (P < 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%).

Conclusions: 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.

Figures

Grahic Jump Location
Figure.
Patients that formed the study cohort.

The asterisk indicates that these 219 participants were recruited between August 1996 and February 2002, and all instances of left atrial thrombus occurred in the left atrial appendage. PTMC = percutaneous transvenous mitral commissurotomy.

Grahic Jump Location

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Summary for Patients

Dissolving Left Atrial Clots in Patients with Mitral Stenosis

The summary below is from the full report titled “Resolution of Left Atrial Thrombus after 6 Months of Anticoagulation in Candidates for Percutaneous Transvenous Mitral Commissurotomy.” It is in the 20 January 2004 issue of Annals of Internal Medicine (volume 140, pages 101-105). The authors are S. Silaruks, B. Thinkhamrop, S. Kiatchoosakun, C. Wongvipaporn, and P. Tatsanavivat.

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