RT-141
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Effects of anticoagulation on
atrial thrombi: a transesophageal echocardiographic study
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Giovanni Corrado, Giorgio Tadeo,
Sandro Beretta*, Giovanni Foglia Manzillo, Manuela Spata, Luca Mario Tagliagambe, Mauro
Santarone.
Servizio di Cardiologia, *Divisione di Neurologia, Ospedale Valduce, Como, Italy
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Abstract
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Background. Prolonged anticoagulation
with oral warfarin of atrial fibrillation > 48 hrs before cardioversion reduces
the embolic risk during cardioversion of atrial fibrillation. The mechanism of this
benefit is generally ascribed to enhanced atrial thrombi organization.
Methods and results. Repeated transesophageal echocardiograms were
performed in 12 patients with rheumatic or nonrheumatic atrial fibrillation or atrial
flutter after identification of atrial thrombi on initial transesophageal study. All
patients were given therapeutic anticoagulation and were followed for clinical signs of
embolism. Atrial thrombus had completely resolved after a median of 4 weeks of oral
warfarin in 10/12 patients (83.3%) who subsequently underwent electrical cardioversion. No
patient had clinical thromboembolism between the two transesophageal echocardiographic
studies and no new thrombi were found on follow-up study.
Conclusions. Among patients with chronic atrial fibrillation/flutter
the mechanism of thromboembolism reduction with 4 weeks of anticoagulation before
cardioversion is related to thrombus lysis rather than organization. However, due to the
possibility of thrombus persistence even after prolonged anticoagulation, follow-up with
transesophageal echocardiography before cardioversion is necessary to document thrombus
resolution.
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Key Words
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Atrial fibrillation – thromboembolic events
anticoagulation therapy, warfarin, thrombus resolution, thrombus organization,
transoesophageal echocardiography, OA
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