RT-143
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Effects of anticoagulant therapy
in patients with atrial fibrillation and intra-atrial thrombosis
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Alberto Menotti, Ferdinando
Imperadore, Giuseppe Vergara, Marcello Disertori*.
Department of Cardiology, Rovereto Hospital, Rovereto,
*Department of Cardiology, S. Chiara Hospital, Trento, Italy
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Abstract
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Background. The use of warfarin
anticoagulation for several weeks before cardioversion results in a 90% reduction in the
incidence of cardioversion-related thromboembolism. The mechanism of this benefit is
debated: some authors attribute it to organization and adherence of atrial thrombi, others
ascribe the benefit to the resolution of thrombi.
Methods. In 63 patients who underwent preliminary transesophageal
echocardiography on cardioversion, 18 (28.5%) were found to have atrial and/or auricolar
thrombosis (4 patients in the right atrium and/or auricola). All patients with thrombosis
continued anticoagulant therapy with warfarin to therapeutic levels (INR 2-3), and 13
patients underwent a follow-up transesophageal echocardiography after 5-12 weeks.
Results. In 7 out of 13 patients (54% of cases) it was documented a
regression of thrombus; no patients evidenced embolic events between the initial and
follow-up transesophageal echocardiography and no new thrombi were identified. Five
patients were successfully cardioverted without embolic complications on follow-up.
Conclusions. These data suggest the hypothesis that, in the majority
of cases, reduction of embolic risk after anticoagulant therapy is due to the resolution
of thrombus rather than its organization. Never the less, the possible persistence of
thrombus (46% in our study), even after 6-8 weeks of anticoagulant therapy indicate the
need for a follow-up transesophageal echocardiography if the patient is a candidate for
cardioversion.
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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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