Universität zu Köln

Schaeffer, Benjamin, Rueden, Lea, Salzbrunn, Tim, Pinnschmidt, Hans O., Akbulak, Ruken Oezge, Moser, Julia Magdalena, Jularic, Mario, Meyer, Christian, Eickholt, Christian ORCID: 0000-0002-5458-9688, Sultan, Arian, Lueker, Jakob, Steven, Daniel, Willems, Stephan and Hoffmann, Boris Alexander (2018). Incidence of intracardiac thrombus formation prior to electrical cardioversion in respect to the mode of oral anticoagulation. J. Cardiovasc. Electrophysiol., 29 (4). S. 537 - 548. HOBOKEN: WILEY. ISSN 1540-8167

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Abstract

Aims: To evaluate the incidence of newly diagnosed intracardiac thrombi (ICT) in respect to the mode of OAC in patients undergoing cardioversion (CV). Methods and results: We prospectively assessed transesophageal echocardiography (TEE) and OAC therapy prior to CV in AF patients with 48-hour duration scheduled for CV. A total of 60 first-time ICT (4.7%) were diagnosed in 1,286 TEE, with highest rate in patients without OAC (9.6%vs. OAC 4.1%, P = 0.009) and an apparently lower rate in nonvitamin K antagonist anticoagulants (NOAC) therapy compared to vitamin K antagonist (VKA) (2.5%vs. 5.3%, P = 0.02). VKA therapy control 4weeks prior to CV was overall average (time in therapeutic range 60%) and patients showed more frequently clinical characteristics and TEE parameters associated with risk for ICT. Even among patients with effective OAC therapy (uninterrupted NOAC and VKA therapy with international normalized ratio (INR) 2.0 for 3 weeks), ICT occurred in 2.7%, but with no difference between both groups (P = 0.22). There was no difference between different types of NOAC. Independent predictors for ICT were history of embolism, hypertension, BMI, absence of OAC, renal function, reduced atrial appendage flow, and presence of spontaneous echo contrast. Conclusion: NOAC therapy seems favorable in the overall prevention of ICT, although this is likely to be caused by suboptimal VKA therapy control and differences in the overall health status between VKA and NOAC patients. ICT occurred even with effective OAC therapy suggesting individual TEE-guided cardioversion in patients at risk.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schaeffer, Benjamin UNSPECIFIED UNSPECIFIED UNSPECIFIED Rueden, Lea UNSPECIFIED UNSPECIFIED UNSPECIFIED Salzbrunn, Tim UNSPECIFIED UNSPECIFIED UNSPECIFIED Pinnschmidt, Hans O. UNSPECIFIED UNSPECIFIED UNSPECIFIED Akbulak, Ruken Oezge UNSPECIFIED UNSPECIFIED UNSPECIFIED Moser, Julia Magdalena UNSPECIFIED UNSPECIFIED UNSPECIFIED Jularic, Mario UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Eickholt, Christian UNSPECIFIED orcid.org/0000-0002-5458-9688 UNSPECIFIED Sultan, Arian UNSPECIFIED UNSPECIFIED UNSPECIFIED Lueker, Jakob UNSPECIFIED UNSPECIFIED UNSPECIFIED Steven, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Willems, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoffmann, Boris Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-192058
DOI:	10.1111/jce.13447
Journal or Publication Title:	J. Cardiovasc. Electrophysiol.
Volume:	29
Number:	4
Page Range:	S. 537 - 548
Date:	2018
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1540-8167
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NONVALVULAR ATRIAL-FIBRILLATION; VITAMIN-K ANTAGONIST; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; THROMBOEMBOLIC RISK; WARFARIN; APIXABAN; EFFICACY; METAANALYSIS; RIVAROXABAN; PREVALENCE Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19205