Anticoagulation Strategies for Atrial Fibrillation Patients with Left Atrial Appendage Thrombus

Abstract

Backgrounds: The anticoagulation therapy is recommended to prevent thromboembolism in the patients with atrial fibrillation (AF). However, thrombus sometimes form at the left atrial appendage (LAA) despite the adequate anticoagulation therapy. The aim of this study is to clarify the therapeutic strategy for AF patients with LAA thrombus. Methods and Results: Among 250 AF patients who were performed the transesophageal echocardiography in our institute from Mar 2008 to May 2011, LAA thrombi were observed in 19 patients (7.6%; 64±9.5 years, male 15, chronic 17). The average value of the prothrombin time-international normalized ratio (PT-INR) in these patients was 1.84±0.34 at that time. All the thrombi had disappeared by administering both heparin and high dose of warfarin for 15±14 days in 9 patients, and high dose of warfarin alone for 85±59 days in the remaining 10. The value of PT-INR has finally reached 2.99±0.52 at the time of thrombus disappearance. The major complications including the hemorrhage had not occurred during the follow-up periods. Conclusions: The intensive anticoagulation therapy targeting the PT-INR value of 3.0 might be considered for the patients with LAA thrombus under regular anticoagulation therapy. The additional use of heparin might shorten the time to thrombus disappearance.