Abstract

Objective To investigate the thrombolysis and safety of patients with non-valvular atrial fibrillation(NVAF)complicated with left atrial appendage(LAA)thrombosis after treatment with non-vitamin K antagonist oral anticoagulants(NOACs, rivaroxaban and dabigatran)and warfarin. Methods This was a retrospective, observational study.We consecutively enrolled NVAF patients with LAA thrombus detected by transesophageal echocardiogram(TEE)and/or left atrium computed tomography(LACT)from January 2016 to October 2017 in Fuwai Hospital.The patients were divided into 3 groups by the use of different anticoagulants: warfarin group(dose: adjusted with target international normalized ratio range 2.0-3.0), rivaroxaban group(dose: 15 mg bid for three weeks then followed by 20 mg qd)and dabigatran group(dose: 110 mg bid). All patients underwent TEE or LACT at 1 month, 2 months, 3 months and 4 months to determine the status of thrombus. Follow-up of bleeding events by telephone. Results A total of 14 cases were enrolled, with four patients receiving warfarin, six patients receiving rivaroxaban, and four patients receiving dabigatran. After 1 month of anticoagulant therapy, thrombolysis of LAA was only observed in one case receiving rivaroxaban, 33%(2/6)and 50%(3/6)in patients taking rivaroxaban, 50%(2/4)and 75%(3/4)in dabigatran group, 0(0/4)and 50%(2/4)in warfarin group at 2-month and 3-month follow-up, respectively. After 4 months’ treatment, all 6 patients had LAA thrombolysis with rivaroxaban(100%)treatment compared to 3 patients receiving dabigatran(75%), and 2 patients taking warfarin(50%). During 4 months’ follow-up, only mucocutaneous hemorrhage was observed in two cases receiving rivaroxaban or warfarin. Conclusion NOACs could be used safely and effectively compared to warfarin in the treatment of LAA thrombus in NVAF in the real world. Key words: Atrial Fibrillation; Left atrial appendage thrombosis; Anticoagulation

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