Data from a study published in the Journal of the American College of Cardiology suggests that the increased instance of ischemic events influences device-related thrombus (DRT) post a left atrial appendage occlusion (LAAO).
Patients with thrombus were assessed for the management patterns and mid-term outcomes by Trevor Simard, MD, Cardiologist at the Mayo Clinic School of Medicine, and his colleagues. In addition, the patient and procedural predictors of DRT were also evaluated by the team.
A limited data concerning the prediction of DRT is available.
The predictors and outcomes of DRT were intended to be evaluated through the study by constructing a DRT registry.
The data of LAOO cases with and without DRT was contributed for the analysis by 37 international centers.
The study included 237 patients with and 474 without DRT. The median follow-up duration for the DRT group was 1.8 years (interquartile range: 0.9-3.0 years) and for the non-DRT group 1.6 years (interquartile range: 1.0-2.9 years).
DRT detected in patients:
Days 0 to 45: 24.9%
Days 45 to 180: 38.8%
Days 180 to 365: 16.0%
After 365 days: 20.3%
25.3% of patients were noted with DRT at the last recorded follow-up.
An elevated risk of ischemic stroke, a composite endpoint of death, or systemic embolization was associated with the presence of DRT, hazard ratio (HR): 2.37; 95% CI, 1.58-3.56; P < 0.001.
Ischemic stroke further increased the risk, HR: 3.49; 95% CI: 1.35-9.00; P = 0.01.
5 DRT risk factors were identified through a multivariable analysis:
Non-paroxysmal atrial fibrillation odds ratio (OR): 1.90; 95% CI: 1.22-2.97
Implantation depth more than 10 mm from the pulmonary vein limbus OR: 2.41; 95% CI: 1.57-3.69
Renal insufficiency OR: 4.02; 95% CI: 1.22-13.25
Pericardial effusion OR: 13.45; 95% CI: 1.46-123.52
Hypercoagulability disorder OR: 17.50; 95% CI: 3.39-90.45
A 2.1-fold increased risk of DRT was seen in patients with 2 or more risk points.
Simard et al. concluded that risk stratification, optimization of procedural techniques, and postprocedural management of LAOO patients could be achieved with DRT prediction using patient and procedural risk factors.