Symptomatic vs. non-symptomatic device-related thrombus after LAAC: a sub-analysis from the multicenter EUROC-DRT registry.
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Vij Vivian, Cruz-González Ignacio, Galea Roberto, Piayda Kerstin, Nelles Dominik, Vogt Lara, Gloekler Steffen, Fürholz Monika, Meier Bernhard, Räber Lorenz, O'Hara Gilles, Arzamendi Dabit, Agudelo Victor, Asmarats Lluis, Freixa Xavier, Flores-Umanzor Eduardo, De Backer Ole, Sondergaard Lars, Nombela-Franco Luis, McInerney Angela, Salinas Pablo, Korsholm Kasper, Nielsen-Kudsk Jens Erik, Afzal Shazia, Zeus Tobias, Operhalski Felix, Schmidt Boris, Montalescot Gilles, Guedeney Paul, Iriart Xavier, Miton Noelie, Saw Jacqueline, Gilhofer Thomas, Fauchier Laurent, Veliqi Egzon, Meincke Felix, Petri Nils, Nordbeck Peter, Gonzalez-Ferreiro Rocio, Bhatt Deepak L, Laricchia Alessandra, Mangieri Antonio, Omran Heyder, Schrickel Jan Wilko, Rodes-Cabau Josep, Nickenig Georg, Sievert Horst, Sedaghat Alexander
Аннотация
AIMS: This study aimed to identify predisposing factors for stroke/SE in DRT patients. In addition, the temporal connection of stroke/SE to DRT diagnosis was analyzed.
METHODS: The EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared.
RESULTS: Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR 37-558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0 ± 9.1% vs. 54.2 ± 11.0%, p = 0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p = 0.06). Other baseline parameters and device positions were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%).
CONCLUSION: Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Identification of risk factors remains cumbersome, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events.