The following is a summary of “Atrial Thrombosis Prevalence before Cardioversion or Catheter Ablation of Atrial Fibrillation: An Update Systematic Review and Meta-Analysis of Direct Oral Anticoagulants Versus Vitamin K Antagonists,” published in the March 2024 issue of Cardiology by Troisi et al.
Left atrial or left atrial appendage thrombosis (LAT) presents a contraindication for cardiac ablation (CA) or cardioversion (CV) procedures in atrial fibrillation (AF).
Researchers conducted a retrospective study to assess the incidence of left atrial or LAT detected via transesophageal echocardiography (TEE) before CA or CV in patients with AF receiving treatment with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs).
They systematically reviewed studies from PubMed, Scopus, Web of Science, and the Cochran Library databases, spanning from their inception to July 13, 2023. These studies were chosen based on their reporting of data regarding LAT identification before CA or CV in patients with AF who were undergoing treatment with DOACs or VKAs. Utilizing TEE, they extracted relevant information. Using a random-effects model, pooled ORs and their 95% CIs were calculated for the analysis.
The results showed that of the 50 studies retrieved (comprising 38 observational studies), 29 focused on CA, 15 on CV, and 6 on both procedures. The study included 17,096 patients on DOACs and 13,666 on VKAs. The overall prevalence of LAT was lower in patients on DOACs compared to those on VKAs, with an OR of 0.66 (95% CI: 0.52-0.84). This trend was consistently confirmed in sensitivity analysis and across most subgroups. The pooled OR for LAT was 0.68 (0.50-0.90) for Apixaban, 0.67 (0.51-0.88) for Dabigatran, 0.61 (0.43-0.89) for Rivaroxaban, and 1.10 (0.74-1.64) for Edoxaban (not statistically significant).
Investigators concluded that DOAC therapy in AF patients may be associated with a lower prevalence of left atrial thrombus than VKA, suggesting further investigation into their protective effects against blood clot formation in the left atrium.
Source: ajconline.org/article/S0002-9149(24)00174-7/abstract#%20