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Sun Y, Hu X, Xu C, Zhang M, Wu S, Qin M, Liu X, Dong Y. Investigating the combinatorial effects of radiofrequency ablation and anticoagulants in patients with atrial fibrillation and left atrial appendage thrombosis after successful thrombolysis. Exp Ther Med 2024; 28:407. [PMID: 39268372 PMCID: PMC11391180 DOI: 10.3892/etm.2024.12696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 08/08/2024] [Indexed: 09/15/2024] Open
Abstract
The present study investigated the synergistic effects of radiofrequency ablation and various anticoagulants on adverse outcomes in patients with atrial fibrillation (AF) and left atrial appendage thrombosis following successful thrombolysis. Patients diagnosed with AF and left atrial appendage thrombosis post-successful thrombolysis (n=92) were retrospectively analysed. They were divided into two groups: Group A received radiofrequency ablation combined with an anticoagulant, while Group B received an anticoagulant alone and in combination with antiarrhythmic drugs. Subgroup analyses were conducted based on left atrial diameter (>45 mm), duration of AF (>1 year) and types of anticoagulants. Univariate and multivariate logistic regression analyses were performed to assess stroke and mortality risks in patients with AF with left atrial appendage thrombosis after dissolution. Multivariate logistic regression analysis identified AF duration (>1 year), left atrial diameter (>45 mm) and BNP level as significant risk factors for stroke (P<0.05). Compared with NOACs, the traditional anticoagulants (warfarin) demonstrated higher survival rates and lower stroke incidence in Group B (P<0.05); however, no significant difference was observed within Group A (P>0.05). Radiofrequency ablation combined with anticoagulants appeared to be more effective in treating AF with left atrial appendage thrombosis post-dissolution compared with anticoagulants alone. Attention to AF duration and left atrial diameter is crucial during early patient management. However, the choice between warfarin or NOACs for patients with AF and left atrial appendage thrombosis warrants further investigation.
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Affiliation(s)
- Yuzhang Sun
- Graduate School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, P.R. China
| | - Xiaofeng Hu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Chest Hospital, Shanghai 200030, P.R. China
| | - Changhao Xu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Chest Hospital, Shanghai 200030, P.R. China
| | - Menghe Zhang
- Department of Cardiology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, P.R. China
| | - Shaohui Wu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Chest Hospital, Shanghai 200030, P.R. China
| | - Mu Qin
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Chest Hospital, Shanghai 200030, P.R. China
| | - Xu Liu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Chest Hospital, Shanghai 200030, P.R. China
| | - Yujiang Dong
- Graduate School, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, P.R. China
- Department of Cardiology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250355, P.R. China
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Hagendorff A, Stöbe S, Helfen A, Knebel F, Altiok E, Beckmann S, Bekfani T, Binder T, Ewers A, Hamadanchi A, Freyhaus HT, Groscheck T, Haghi D, Knierim J, Kruck S, Lenk K, Merke N, Pfeiffer D, Dorta ER, Ruf T, Sinning C, Wunderlich NC, Brandt R, Ewen S. Echocardiographic assessment of left atrial appendage morphology and function-an expert proposal by the German Working Group of Cardiovascular Ultrasound. Clin Res Cardiol 2024:10.1007/s00392-024-02492-5. [PMID: 39196343 DOI: 10.1007/s00392-024-02492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/04/2024] [Indexed: 08/29/2024]
Abstract
The left atrial appendage is a blind ending cardiac structure prone to blood stasis due to its morphology. This structure is a preferred region of thrombogenesis in relation to reduced myocardial contractility of the atrial wall. Blood stasis occurs primarily in low flow conditions. One of the tasks of echocardiography is the analysis of morphology and function of the left atrial appendage. The detection of thrombi by echocardiography is difficult and must be carried out thoroughly and carefully to avoid potential complications-especially in the context of rhythm control. The assessment of thromboembolic risk, especially in patients with unknown and presumed atrial fibrillation is a second challenge by characterizing atrial function and flow conditions in the left atrial appendage. Thus, this proposal focuses on the obvious problems of echocardiography when assessing left atrial appendage and the role of this method in planning a potential interventional closure of left atrial appendage.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University Hospital Leipzig AöR, Leipzig, Germany.
| | - Stephan Stöbe
- Department of Cardiology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Andreas Helfen
- Department of Kardiologie, Katholische St. Paulus Gesellschaft, St.-Marien-Hospital Lünen, Lünen, Germany
| | - Fabian Knebel
- Department of Internal Medicine II, Cardiology, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Ertunc Altiok
- Department of Cardiology, Angiology, and Intensive Medicine, University Hospital Aachen, Aachen, Germany
| | - Stephan Beckmann
- Privatpraxis Kardiologie, Beckmann Ehlers Und Partner, Berlin-Grunewald, Germany
| | - Tarek Bekfani
- Department of Cardiology and Angiology, University Hospital Magdeburg AöR, Magdeburg, Germany
| | - Thomas Binder
- Department of Cardiology, University Hospital AKH, Vienna, Austria
| | - Aydan Ewers
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Ali Hamadanchi
- Department of Cardiology, University of Jena, Jena, Germany
| | - Henrik Ten Freyhaus
- Department of Internal Medicine III, Cardiology, University of Cologne, Cologne, Germany
| | - Thomas Groscheck
- Department of Cardiology and Angiology, University Hospital Magdeburg AöR, Magdeburg, Germany
| | - Dariush Haghi
- Kardiologische Praxisklinik Ludwigshafen-Akademische Lehrpraxis of the University of Mannheim, Ludwigshafen, Germany
| | - Jan Knierim
- Department of Internal Medicine and Cardiology, Paulinenkrankenhaus Berlin, Berlin, Germany
| | - Sebastian Kruck
- Praxis Für Kardiologie Cardio Centrum Ludwigsburg, Ludwigsburg, Germany
| | - Karsten Lenk
- Department of Cardiology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Nicolas Merke
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Charité Berlin, Berlin, Germany
| | | | - Elena Romero Dorta
- Department of Cardiology, Angiology and Intensive Care Medicine, University of Berlin, Deutsches Herzzentrum Charité Berlin, Campus Mitte, Berlin, Germany
| | - Tobias Ruf
- Department of Cardiology, Center of Cardiology, Heart Valve Center, University Medical Center Mainz, University of Mainz, Mainz, Germany
| | - Christoph Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, German Centre of Cardiovascular Research (DZHK), Hamburg, Germany
| | | | - Roland Brandt
- Department of Cardiology, Kerckhoff Klinik GmbH, Bad Nauheim, Germany
| | - Sebastian Ewen
- Department Cardiology and Intensive Care Medicine, Schwarzwald-Baar Klinik, Villingen-Schwenningen, Germany
- University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany
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3
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Liu H, Lin M, Han W, Ge J, Maduray K, Zhong J. The risk factors of thrombus formation and the effect of catheter ablation on repetitive thrombus formation in patients with atrial fibrillation: a single center retrospective study in China. BMC Cardiovasc Disord 2023; 23:28. [PMID: 36650447 PMCID: PMC9843887 DOI: 10.1186/s12872-023-03050-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) predisposes patients to the formation of atrial thrombi. The CHA2DS2-VASc score does not include all risk factors for atrial thrombosis. The present study is designed to explore the influencing factors of thrombus formation in patients with AF and to investigate the effect of catheter ablation (CA) on recurrent thrombosis in patients with a history of intracardiac thrombus. METHODS (1) This study consisted of 1726 patients that underwent CA, among which 58 patients had a history of intracardiac thrombus prior to CA. The risk factors for thrombus formation were explored by comparing the baseline clinical characteristics of patients with and without atrial thrombus. (2) The left atrial appendage flow velocity (LAAFV) in patients with a history of intracardiac thrombus who were willing to undergo transesophageal echocardiography (TEE) at the latest follow-up were examined, and comparisons of the LAAFV was made before and after CA. RESULTS The median follow-up period is 13 months. Persistent AF was found to be the only independent risk factor affecting the formation of atrial thrombus among the investigated factors (OR 3.152; 95%CI 1.806-5.500; p < 0.001). Twenty-seven patients agreed to undergo TEE during follow-up, no clinical ischemic stroke events were recorded, no recurrent intracardiac thrombus formation was detected in patients, 15 patients maintained sinus rhythm (55.6%) during follow-up; successful CA significantly increased LAAFV (difference between latest evaluation prior to CA 17.46 ± 14.81 cm/s, p < 0.001). CONCLUSIONS Persistent AF is the only independent risk factor for thrombus formation. Successful CA may improve the LAAFV and thereby decrease the risk of intracardiac thrombus formation.
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Affiliation(s)
- Huiyu Liu
- grid.452402.50000 0004 1808 3430The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China ,Department of Cardiology, Nanyang Central Hospital, Nanyang, China
| | - Mingjie Lin
- grid.27255.370000 0004 1761 1174Department of Cardiology, Qilu Hospital (Qingdao) of Shandong University, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035 Shandong China
| | - Wenqiang Han
- grid.452402.50000 0004 1808 3430The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Junye Ge
- grid.452402.50000 0004 1808 3430The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Kellina Maduray
- grid.452402.50000 0004 1808 3430The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Jingquan Zhong
- grid.452402.50000 0004 1808 3430The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China ,grid.27255.370000 0004 1761 1174Department of Cardiology, Qilu Hospital (Qingdao) of Shandong University, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035 Shandong China
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Uziȩbło-Życzkowska B, Kapłon-Cieślicka A, Gawałko M, Budnik M, Starzyk K, Wożakowska-Kapłon B, Daniłowicz-Szymanowicz L, Kaufmann D, Wójcik M, Błaszczyk R, Hiczkiewicz J, Łojewska K, Mizia-Stec K, Wybraniec M, Kosmalska K, Fijałkowski M, Szymańska A, Gos A, Haberka M, Kucio M, Michalski B, Kupczyńska K, Tomaszuk-Kazberuk A, Wilk-Śledziewska K, Wachnicka-Truty R, Koziński M, Burchardt P, Krzesiński P. Risk factors for left atrial thrombus in younger patients (aged < 65 years) with atrial fibrillation or atrial flutter: Data from the multicenter left atrial thrombus on transesophageal echocardiography (LATTEE) registry. Front Cardiovasc Med 2022; 9:973043. [PMID: 36312270 PMCID: PMC9611536 DOI: 10.3389/fcvm.2022.973043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Our aim was to assess the characteristics and to identify predictors of left atrial thrombus (LAT) in patients under age 65 with atrial fibrillation (AF) or atrial flutter (AFl). Methods We conducted a subanalysis of a multicenter, prospective, observational study [the LATTEE registry]. Consecutive AF/AFl patients referred for cardioversion or ablation were enrolled. Results Of the 3,109 patients included in the study, 1,276 were under age 65 (41%). Compared to non-LAT patients, those with LAT (n = 76) had higher CHA2DS2-VASc score (p < 0.001), more frequently had non-paroxysmal AF/AFl (p < 0.001), heart failure (p < 0.001), history of diabetes mellitus (p = 0.001), transient ischemic attack (p = 0.04), coronary artery disease (p = 0.02), and chronic kidney disease (p < 0.001). The LAT patients were also more often smokers (p = 0.004) and were more frequently treated with vitamin K antagonists (VKAs) (p < 0.001). Transthoracic echocardiography revealed a higher left atrial area (p < 0.001), lower left ventricular ejection fraction (LVEF) (p < 0.001), and lower value of LA appendage emptying volume in LAT than in non-LAT patients (p < 0.001). LVEF (OR 2.95; 95% CI: 1.32-6.59, p = 0.008), non-paroxysmal AF/AFl (OR 7.1; 95% CI: 2.05-24.63, p = 0.002) and treatment with VKAs (OR 4.92; 95% CI: 2.48-9.75, p < 0.001) were identified as independent predictors of LAT in younger patients. Conclusions Our study, which focused on younger patients with AF/AFl, indicated substantial clinical and echocardiographic differences between participants with and without LAT. In the AF/AFl patients younger than age 65, the independent predictors of LAT included non-paroxysmal AF/AFl, lower LVEF, and treatment with VKAs.
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Affiliation(s)
| | - Agnieszka Kapłon-Cieślicka
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Gawałko
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- West German Heart and Vascular Centre, Institute of Pharmacology, University Duisburg-Essen, Duisburg, Germany
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Monika Budnik
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Maciej Wójcik
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Jarosław Hiczkiewicz
- Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
- Clinical Department of Cardiology, Nowa Sól Multidisciplinary Hospital, Nowa Sol, Poland
| | - Katarzyna Łojewska
- Clinical Department of Cardiology, Nowa Sól Multidisciplinary Hospital, Nowa Sol, Poland
| | - Katarzyna Mizia-Stec
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- Members of the European Reference Network on Heart Diseases–ERN GUARD-HEART, Amsterdam, Netherlands
| | - Maciej Wybraniec
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- Members of the European Reference Network on Heart Diseases–ERN GUARD-HEART, Amsterdam, Netherlands
| | | | - Marcin Fijałkowski
- 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Szymańska
- Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland
| | - Aleksandra Gos
- Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland
| | - Maciej Haberka
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Michał Kucio
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Błazej Michalski
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Karolina Kupczyńska
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | | | - Renata Wachnicka-Truty
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, Gdynia, Poland
| | - Marek Koziński
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, Gdynia, Poland
| | - Paweł Burchardt
- “Club 30”, Polish Cardiac Society, Katowice, Poland
- Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
- “Club 30”, Polish Cardiac Society, Katowice, Poland
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Left Atrial Appendage Depth and Tachycardia Bradycardia Syndrome as Important Predictors of Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4632823. [PMID: 35401785 PMCID: PMC8986422 DOI: 10.1155/2022/4632823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 11/17/2022]
Abstract
Background Atrial fibrillation (AF) is the most common heart rhythm disorder that has been shown to be associated with a significant increase in stroke and systemic embolism risk. The left atrial appendage (LAA) is a finger-like extension originating from the left atrium; the formation of thrombus in LAA is the main reason of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). This study is aimed at finding out the risk of left atrial appendage thrombus (LAAT) in patients with nonvalvular atrial fibrillation (NVAF). Method We retrospectively examined the clinic and left atrial computer tomography angiography (CTA) features of patients assessed in Zhengzhou No. 7 People's Hospital between January 2020 and January 2021 derivation. Student's t-test, chi-square test, receiver operating characteristics (ROC) curves, and logistic regression analysis were used to identify predictors of LAAT. Result Of 480 patients included in the analysis, LAAT was found in approximately 9.2% of all patients. Univariate demographic predictors of LAAT included left atrium top and bottom diameter (LTD), left atrial appendage depth (LAAD), CHA2DS2-VASc, tachycardia bradycardia syndrome (TBS), and nonparoxysmal atrial fibrillation (PAF). In a multiple logistic regression analysis, the independent predictors of thrombus were LAAD > 23.45 mm (odds ratio: 4.216, 95% CI: 1.869-9.510, P = 0.001), TBS (odds ratio: 4.076, 95% CI: 1.655-10.038, P = 0.002), and non-PAF (odds ratio: 2.896, 95% CI: 1.183-7.094, P = 0.02). Conclusion In NVAF patients with LAAT, evidence suggested that larger LAAD, non-PAF, and TBS present a high risk of LAAT. This is the first report demonstrating that the LAAD and TBS are associated with LAAT in patients with NVAF.
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Uziębło-Życzkowska B, Krzesiński P, Maciorowska M, Gorczyca I, Jelonek O, Wójcik M, Błaszczyk R, Kapłon-Cieślicka A, Gawałko M, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Szpotowicz A, Krzciuk M, Bednarski J, Bakuła-Ostalska E, Tomaszuk-Kazberuk A, Szyszkowska A, Wełnicki M, Mamcarz A, Wożakowska-Kapłon B. Antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, including compliance with current guidelines-data from the POLish Atrial Fibrillation (POL-AF) Registry. Cardiovasc Diagn Ther 2021; 11:14-27. [PMID: 33708474 PMCID: PMC7944221 DOI: 10.21037/cdt-20-839] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although triple antithrombotic therapy (TAT) is recommended in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), guidelines allow an option of dual antithrombotic therapy (DAT). This study assesses the everyday practice of 10 cardiology departments in antithrombotic therapy in AF patients undergoing PCI and its agreement with current guidelines. METHODS This analysis included medical data of AF patients enrolled in the prospective, observational registry (The POLish Atrial Fibrillation-POL-AF) that underwent PCI [elective or due to acute coronary syndrome (ACS)]. RESULTS Of the 3,999 consecutive subjects included, a final analysis was performed on 359 patients that underwent PCI: 148 with urgent PCI due to ACSand 211 patients with elective PCI. Eighty patients in the ACS-group and 120 patients in the elective-PCI group were treated with TAT, although guidelines also allowed DAT. Of 316 patients treated with oral anticoagulants as a part of combination therapy, 275 were on non-vitamin K antagonist oral anticoagulant (NOAC). Reduced doses of NOAC were used in 74 patients treated with rivaroxaban, 60 patients with dabigatran, and 54 patients with apixaban. The proportion of patients treated with reduced NOAC doses adequately to the guidelines was 29%, 100%, and 33% for rivaroxaban, dabigatran, and apixaban, respectively. Inappropriate low doses of NOACs were used in 71% of subjects on rivaroxaban and 67% on apixaban. CONCLUSIONS In patients with AF undergoing PCI, NOACs are definitely preferred over vitamin-K antagonists (VKAs) in TAT/DAT, and an aggressive antithrombotic strategy with TAT is frequently chosen even if DAT is permissible by the guidelines. Label adherence of using reduced NOAC dose during combination therapy is not satisfactory for apixaban and rivaroxaban and probably results from too cautious an approach to the known indications for reduced therapy. The study is registered in the database Clinical Trials-NCT04419012.
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Affiliation(s)
| | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Małgorzata Maciorowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Iwona Gorczyca
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | | | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Michał Wojewódzki
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Anna Szpotowicz
- Department of Cardiology, Regional Hospital, Ostrowiec Świętokrzyski, Poland
| | - Małgorzata Krzciuk
- Department of Cardiology, Regional Hospital, Ostrowiec Świętokrzyski, Poland
| | - Janusz Bednarski
- Department of Cardiology, St John Paul II Western Hospital, Grodzisk Mazowiecki, Poland
| | | | | | - Anna Szyszkowska
- Department of Cardiology, University Hospital of Bialystok, Białystok, Poland
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, Warsaw, Poland
| | - Beata Wożakowska-Kapłon
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
- Collegium Medicum, The Jan Kochanowski University, Kielce, Poland
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