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- Title
Oral anticoagulation and left atrial thrombi resolution in nonrheumatic atrial fibrillation or flutter: A systematic review and meta‐analysis.
- Authors
Wang, Norman C.; Sather, Matthew D.; Hussain, Aliza; Althouse, Andrew D.; Adelstein, Evan C.; Jain, Sandeep K.; Katz, William E.; Shalaby, Alaa A.; Voigt, Andrew H.; Saba, Samir
- Abstract
Abstract: Background: Oral anticoagulation (OAC) is prescribed for left atrial thrombi (LAT) in nonrheumatic atrial fibrillation (AF) and/or atrial flutter (AFL). The study objective was to review the existing evidence regarding LAT resolution in nonrheumatic AF and/or AFL with OAC agents. Methods: Data sources included PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) between January 1, 1991 and February 10, 2017. English‐language studies that assessed LAT resolution with OAC agents in subjects with nonrheumatic AF and/or AFL, by serial transesophageal echocardiography, and with follow‐up times ≥ 3 weeks and < 1 year, were selected. Study quality was assessed using recommendations adapted from the Agency for Healthcare Research and Quality. Pooled LAT resolution rates were evaluated for vitamin K antagonist (VKA) studies and low risk of bias warfarin studies. Results: The pooled LAT resolution rate of 619 subjects from 16 VKA studies was 63.7% (95% confidence interval [CI], 53.3%–72.9%). The pooled LAT resolution rate of 94 subjects from four studies that specified warfarin use, exclusion of prior long‐term therapeutic OAC, and target international normalized ratio (INR) ≥ 2.0 and/or average achieved INR ≥ 2.0 was 79.3% (95% CI, 69.8%–86.4%). Two studies in direct‐acting oral anticoagulants (DOACs) reported LAT resolution rates of 89.5% (17 of 19) for dabigatran and 41.5% (22 of 53) for rivaroxaban. Conclusions: Warfarin is the most studied initial OAC agent for treating LAT in nonrheumatic AF and/or AFL with a resolution rate of nearly 80%. Further studies in DOACs are warranted.
- Subjects
THROMBOLYTIC therapy; BENZIMIDAZOLES; DRUG therapy; WARFARIN; PYRIDINE; RIVAROXABAN; ANTICOAGULANTS; ATRIAL fibrillation; CONFIDENCE intervals; INFORMATION storage &; retrieval systems; MEDICAL databases; MEDICAL information storage &; retrieval systems; MEDLINE; META-analysis; ONLINE information services; ORAL drug administration; TRANSESOPHAGEAL echocardiography; VITAMIN K; ATRIAL flutter; SYSTEMATIC reviews; TREATMENT effectiveness; INTERNATIONAL normalized ratio; LEFT heart atrium; CHEMICAL inhibitors; THERAPEUTICS
- Publication
Pacing & Clinical Electrophysiology, 2018, Vol 41, Issue 7, p767
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/pace.13368