Oral anticoagulation and left atrial thrombi resolution in nonrheumatic atrial fibrillation or flutter: A systematic review and meta‐analysis. Issue 7 (4th June 2018)

• Record Type: Journal Article
• Authors: Wang, Norman C.; Sather, Matthew D.; Hussain, Aliza; Althouse, Andrew D.; Adelstein, Evan C.; Jain, Sandeep K.; Katz, William E.; Shalaby, Alaa A.; Voigt, Andrew H.; Saba, Samir
• Is Part Of: Pacing and clinical electrophysiology. Volume 41:Issue 7(2018)
• Page Start: 767
• Page End: 774
• Publication Date: 2018-06-04
• Subjects: atrial fibrillation -- atrial flutter -- left atrial thrombi -- oral anticoagulation; Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.13368
• Languages: English
• ISSNs: 0147-8389

Abstract

Abstract: Background: Oral anticoagulation (OAC) is prescribed for left atrial thrombi (LAT) in nonrheumatic atrial fibrillation (AF) and/or atrial flutter (AFL). The study objective was to review the existing evidence regarding LAT resolution in nonrheumatic AF and/or AFL with OAC agents. Methods: Data sources included PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) between January 1, 1991 and February 10, 2017. English‐language studies that assessed LAT resolution with OAC agents in subjects with nonrheumatic AF and/or AFL, by serial transesophageal echocardiography, and with follow‐up times ≥ 3 weeks and < 1 year, were selected. Study quality was assessed using recommendations adapted from the Agency for Healthcare Research and Quality. Pooled LAT resolution rates were evaluated for vitamin K antagonist (VKA) studies and low risk of bias warfarin studies. Results: The pooled LAT resolution rate of 619 subjects from 16 VKA studies was 63.7% (95% confidence interval [CI], 53.3%–72.9%). The pooled LAT resolution rate of 94 subjects from four studies that specified warfarin use, exclusion of prior long‐term therapeutic OAC, and target international normalized ratio (INR) ≥ 2.0 and/or average achieved INR ≥ 2.0 was 79.3% (95% CI, 69.8%–86.4%). Two studies in direct‐acting oral anticoagulants (DOACs) reported LAT resolution rates of 89.5% (17 of 19) for dabigatran and 41.5% (22 of 53) for rivaroxaban. Conclusions: Warfarin is the most studied initial OAC agent for treating LAT in nonrheumatic AF and/or AFL with a resolution rate of nearly 80%. Further studies in DOACs are warranted.