Left atrial appendage thrombus with severe mitral stenosis, responders, and non-responders with anticoagulation
The current study aimed to determine the resolution of LAA thrombus on TEE after three months of optimal anticoagulation among patients with different types of LAA at baseline cardiac CT of patients with severe MS. A total of 88 patients were included, with mean age of 37.95 ± 12.08 years. Repeat TEE showed thrombus resolution in only 27.3% patients. The rate of resolution of thrombus was in 8/12 (66.7%), 4/28 (14.3%), 8/36 (22.2%), and 4/12 (33.3%) for patients with cactus, cauliflower, chicken wing, and windsock type of LAA, respectively.
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The current study was a prospective, observational, multicenter cohort study. Ethical approval was obtained from Pakistan Medical Association Ethics Committee (Reference no. JZ/036/SRO/05) and was registered at ClinicalTrials.gov, with trial registration number NCT05186649. Study inclusion criteria were; patients diagnosed with severe mitral stenosis with thrombus in the LAA detected on first TEE, either gender, and between 18 and 65 years of age. The TEE was performed in all patients as part of routine pre-PTMC clinical workup. Upon confirmation of presence of thrombus in LAA on TEE, a cardiac CT was performed for the delineation of type of LAA and to determine it morphology. Four different LAA types were classified as “cauliflower”, “windsock”, “cactus”, and “chicken wing” . Regardless of type of LAA, all the recruited patients were put on an oral dose of anticoagulation with Warfarin. The INR was to be maintained between 2.5 and 3.5. Patients have initially been prescribed Warfarin with 5 mg of daily dosage. The INR test results were obtained for all the patients on weekly basis and daily dosage was adjusted at each weekly test based on the target INR range. After three months of complete anticoagulation therapy, a repeat TEE was performed, and resolution of thrombus was assessed. Non-resolving thrombus (non-responders) were sent for surgery and responders were put on list of PTMC.