Arrhythmias & electrophysiologyCohort study
Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure
- Multicentre registry study
- international
Authors' conclusion
About one-third of DRT events had an unfavorable evolution (either persisting or recurring), with a larger initial thrombus size (particularly >7 mm) portending an increased risk. Unfavorable evolution of DRT was associated with a 2-fold higher risk of thromboembolic events compared with resolved DRT.
Study context
- Population
- Left atrial appendage closure (LAAC) recipients with device-related thrombus and subsequent imaging after initial device-related thrombus (DRT) diagnosisof 237 with DRT
- Participants
- 214 recipients
- Exposure
- Unfavorable evolution vs resolved DRT
- Unfavorable evolutionn = 75
- Outcome
- Incidence, predictors and clinical impact of persistent and recurrent DRT
Main finding
As reported in the abstract
Evolution of DRT
DRT resolved
153 (71.5%)
DRT persisted
61 (28.5%)
Recurrent DRT among 82 with repeated imaging after resolution
14 (17.1%)
Unfavorable evolution overall
75 (35.0%)
Observational data: associations, not effects.
Further findings
| Outcome | Unfavorable evolution | Resolved DRT | Estimate | P value | |
|---|---|---|---|---|---|
| Predictors of persistent DRT — Larger DRT size (per 1-mm increase) · independent | OR 1.08 (95% CI 1.02–1.15) | P = 0.009 | |||
| Predictors of persistent DRT — Female vs Resolved DRT · independent | OR 2.44 (95% CI 1.12–5.26) | P = 0.02 | |||
| Predictor of unfavorable evolution: average thrombus size at initial diagnosis — Thrombus size (per 1-mm increase) · sole predictor | OR 1.09 (95% CI 1.03–1.16) | P = 0.003 | |||
| Predictor of unfavorable evolution: average thrombus size at initial diagnosis — Size cutoff 7 mm vs Resolved DRT · optimal cutoff | OR 2.51 (95% CI 1.39–4.52) | P = 0.002 | |||
| Thromboembolic events | 26.7% | 15.1% | HR 2.13 (95% CI 1.15–3.94) | P = 0.02 | |
| 0.20.5125Ratio (log scale) |
Original publication
Persistent and Recurrent Device-Related Thrombus After Left Atrial Appendage Closure. JACC Cardiovasc Interv. Published 27 November 2023. doi:10.1016/j.jcin.2023.09.017
Summarised from the published abstract; every number is checked against it