O.S. Sychov, A.O. Borodai, E.S. Borodai. Prediction of left atrial appendage thrombus and sludge in patients with non-valvular atrial fibrillation and impact of anticoagulation on their assessment.

The aim – to evaluate clinical and echocardiographic predictors of left atrial appendage sludge and/or thrombus in patients with non-valvular atrial fibrillation and to assess impact of prior and following anticoagulation on their prevalence and progression.

Material and methods. In prospective observational study we examined 182 patients with non-valvular atrial fibrillation. Atrial thrombi were detected in 11 % cases and left atrial appendage sludge – in 13.2 % cases.

Results. Multivariate regression analysis showed that CHA2DS2-VASc score, Sm < 7 cm/s and Еm < 8 cm/s, were independently associated with thrombi formation markers. Before inclusion in the study 48.6 % patients did not use antithrombotic therapy at all. In the group without anticoagulants atrial thrombi and sludge were detected in 13,5 % and 12,4 % patients respectively, the rate of detection atrial thrombi and sludge in the group of warfarin were 16.9 % and 9,85 % respectively. Under anticoagulation TEE detection of atrial thrombi was decreased by 73.7 % and sludge – by 53.3 %. Conclusions. CHA2DS2-VASc score and echocardiographic parameters Sm < 7 cm/s and Еm < 8 cm/s may be used for prognosis of atrial thrombi and sludge in patients with non-valvular atrial fibrillation. Due to inability to control international normalized ratio in therapeutic range conventional anticoagulation before cardioversion is often ineffective, and TEE with short-term warfarin pretreatment or novel oral anticoagulants is preferred before cardioversion.

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