Abstract
Objective: Warfarin anticoagulation significantly reduces the risk of thromboembolism in patients with atrial fibrillation (AF). However, there are many patients with AF who begin anticoagulation only after left atrial thrombus (LAT) is detected by transesophageal echocardiography (TEE). The impact of anticoagulation in these patients has not been clearly described. The purpose of this study was to investigate the incidence of cerebrovascular accident (CVA) among AF patients who began warfarin before LAT was detected by TEE compared to those who began warfarin only after TEE demonstrated LAT and those did not receive warfarin at any point. Method: Of the 90 consecutive AF patients with LAT (male 48, female 42, age 71.5 ± 10.1 years), 49 began warfarin more than 3 weeks before TEE (Group I); 29 began warfarin after TEE (Group II); and 12 did not receive warfarin at all (Group III). Results: The incidence of CVA in Group I (14%, 7/49, prior CVA 5, new CVA after TEE 2) was significantly lower than Group II (45%, 13/29, prior CVA 10, new CVA after TEE 3, P = 0.006) and III (42%, 5/12, prior CVA 3, new CVA after TEE 2, P = 0.047). Patients with persistent LAT had significantly higher incidence (64% vs 23%, P = 0.024) of CVA and lower CVA free survival than those with resolved LAT. Conclusion: The incidence of CVA among AF patients, who began warfarin before LAT detection, is significantly lower than those who began warfarin after LAT detection as well as those who did not receive warfarin at all.
| Original language | English |
|---|---|
| Pages (from-to) | 14-19 |
| Number of pages | 6 |
| Journal | Echocardiography |
| Volume | 24 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2007 |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
- Radiology Nuclear Medicine and imaging
Cite this
Warfarin therapy initiated before is more beneficial than after transesophageal echocardiography detected left atrial thrombus. / Shen, Xuedong; Li, Huagui; Nair, Chandra K.; Holmberg, Mark Jeffrey; Lakkireddy, Dhanunjay; Cloutier, David; Rovang, Karen; Hee, Tom; Mooss, Aryan N.; Mohiuddin, Syed M.
In: Echocardiography, Vol. 24, No. 1, 01.2007, p. 14-19.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Warfarin therapy initiated before is more beneficial than after transesophageal echocardiography detected left atrial thrombus
AU - Shen, Xuedong
AU - Li, Huagui
AU - Nair, Chandra K.
AU - Holmberg, Mark Jeffrey
AU - Lakkireddy, Dhanunjay
AU - Cloutier, David
AU - Rovang, Karen
AU - Hee, Tom
AU - Mooss, Aryan N.
AU - Mohiuddin, Syed M.
PY - 2007/1
Y1 - 2007/1
N2 - Objective: Warfarin anticoagulation significantly reduces the risk of thromboembolism in patients with atrial fibrillation (AF). However, there are many patients with AF who begin anticoagulation only after left atrial thrombus (LAT) is detected by transesophageal echocardiography (TEE). The impact of anticoagulation in these patients has not been clearly described. The purpose of this study was to investigate the incidence of cerebrovascular accident (CVA) among AF patients who began warfarin before LAT was detected by TEE compared to those who began warfarin only after TEE demonstrated LAT and those did not receive warfarin at any point. Method: Of the 90 consecutive AF patients with LAT (male 48, female 42, age 71.5 ± 10.1 years), 49 began warfarin more than 3 weeks before TEE (Group I); 29 began warfarin after TEE (Group II); and 12 did not receive warfarin at all (Group III). Results: The incidence of CVA in Group I (14%, 7/49, prior CVA 5, new CVA after TEE 2) was significantly lower than Group II (45%, 13/29, prior CVA 10, new CVA after TEE 3, P = 0.006) and III (42%, 5/12, prior CVA 3, new CVA after TEE 2, P = 0.047). Patients with persistent LAT had significantly higher incidence (64% vs 23%, P = 0.024) of CVA and lower CVA free survival than those with resolved LAT. Conclusion: The incidence of CVA among AF patients, who began warfarin before LAT detection, is significantly lower than those who began warfarin after LAT detection as well as those who did not receive warfarin at all.
AB - Objective: Warfarin anticoagulation significantly reduces the risk of thromboembolism in patients with atrial fibrillation (AF). However, there are many patients with AF who begin anticoagulation only after left atrial thrombus (LAT) is detected by transesophageal echocardiography (TEE). The impact of anticoagulation in these patients has not been clearly described. The purpose of this study was to investigate the incidence of cerebrovascular accident (CVA) among AF patients who began warfarin before LAT was detected by TEE compared to those who began warfarin only after TEE demonstrated LAT and those did not receive warfarin at any point. Method: Of the 90 consecutive AF patients with LAT (male 48, female 42, age 71.5 ± 10.1 years), 49 began warfarin more than 3 weeks before TEE (Group I); 29 began warfarin after TEE (Group II); and 12 did not receive warfarin at all (Group III). Results: The incidence of CVA in Group I (14%, 7/49, prior CVA 5, new CVA after TEE 2) was significantly lower than Group II (45%, 13/29, prior CVA 10, new CVA after TEE 3, P = 0.006) and III (42%, 5/12, prior CVA 3, new CVA after TEE 2, P = 0.047). Patients with persistent LAT had significantly higher incidence (64% vs 23%, P = 0.024) of CVA and lower CVA free survival than those with resolved LAT. Conclusion: The incidence of CVA among AF patients, who began warfarin before LAT detection, is significantly lower than those who began warfarin after LAT detection as well as those who did not receive warfarin at all.
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U2 - 10.1111/j.1540-8175.2007.00344.x
DO - 10.1111/j.1540-8175.2007.00344.x
M3 - Article
C2 - 17214617
AN - SCOPUS:33845981047
VL - 24
SP - 14
EP - 19
JO - Echocardiography
JF - Echocardiography
SN - 0742-2822
IS - 1
ER -