Warfarin therapy initiated before is more beneficial than after transesophageal echocardiography detected left atrial thrombus

Xuedong Shen, Huagui Li, Chandra K. Nair, Mark Jeffrey Holmberg, Dhanunjay Lakkireddy, David Cloutier, Karen Rovang, Tom Hee, Aryan N. Mooss, Syed M. Mohiuddin

Research output: Contribution to journalArticle

3 Citations (Scopus)

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 languageEnglish
Pages (from-to)14-19
Number of pages6
JournalEchocardiography
Volume24
Issue number1
DOIs
StatePublished - Jan 2007

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Transesophageal Echocardiography
Warfarin
Thrombosis
Stroke
Atrial Fibrillation
Therapeutics
Incidence
Thromboembolism

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 journalArticle

Shen, Xuedong ; Li, Huagui ; Nair, Chandra K. ; Holmberg, Mark Jeffrey ; Lakkireddy, Dhanunjay ; Cloutier, David ; Rovang, Karen ; Hee, Tom ; Mooss, Aryan N. ; Mohiuddin, Syed M. / Warfarin therapy initiated before is more beneficial than after transesophageal echocardiography detected left atrial thrombus. In: Echocardiography. 2007 ; Vol. 24, No. 1. pp. 14-19.
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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.",
author = "Xuedong Shen and Huagui Li and Nair, {Chandra K.} and Holmberg, {Mark Jeffrey} and Dhanunjay Lakkireddy and David Cloutier and Karen Rovang and Tom Hee and Mooss, {Aryan N.} and Mohiuddin, {Syed M.}",
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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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