Risk of left atrial appendage thrombus in older patients with atrial fibrillation
 
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1
1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
2
Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
3
1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
4
Faculty of Medical and Health Sciences, The Jan Kochanowski University, Kielce, Poland
CORRESPONDING AUTHOR
Agnieszka Kapłon-Cieślicka   

1st Department of Cardiology, Medical University of Warsaw, Poland
Submission date: 2020-07-03
Final revision date: 2020-07-23
Acceptance date: 2020-08-04
Online publication date: 2021-03-03
 
 
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ABSTRACT
Introduction:
We aimed to compare the prevalence of left atrial appendage (LAA) thrombus and its predictors between old and young patients with atrial fibrillation (AF).

Material and methods:
The study included 1970 patients aged ≥ 65 (n = 822 [41.7%]) and < 65 (n = 1148 [58.3%]) referred for AF cardioversion or ablation preceded by transoesophageal echocardiography (TEE).

Results:
Oral anticoagulation (OAC) was prescribed in 799 (97.2%) patients aged ≥ 65 years and in 1054 (91.8%) of those aged < 65 years (p < 0.001). In patients treated with OAC, those aged ≥ 65 years less often received vitamin K antagonist (VKA) (267 [33.4%] vs. 416 [39.5%]) and more often non-VKA-OAC (NOAC) (532 [66.6%] vs. 638 [60.5%], p = 0.008, p = 0.008) compared to patients < 65 years. On TEE, LAA thrombus was more often observed in patients aged ≥ 65 years than those aged < 65 years (63 [7.7%] vs. 46 [4.0%], p < 0.001), with an absolute but not statistically significant difference between patients aged 65–74 and ≥ 75 years (47 [7.3%] vs. 16 [8.8%], p = 0.528). In patients aged ≥ 65 years, there was no difference in the prevalence of LAA thrombus between patients treated with VKA and NOAC, in contrast to patients aged < 65 years, in whom such a difference was observed (27 [6.5%] vs. 16 [2.5%], p = 0.002). In multivariate logistic regression, predictors of LAA thrombus in both age groups were older age, non-paroxysmal AF, and heart failure, whereas only in patients aged < 65 years – VKA use, and in those aged ≥ 65 years – lower glomerular filtration rate and platelet count.

Conclusions:
Despite OAC use, older patients with AF remain at high risk of LAA thrombus formation. Older age, non-paroxysmal AF, and heart failure are predictors of LAA thrombus, irrespective of age.

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