Resolution of left atrial thrombus after 6 months of anticoagulation in candidates for percutaneous transvenous mitral commissurotomy.
BACKGROUND
Resolution of left atrial thrombus after long-term oral anticoagulation enhances safe percutaneous transvenous mitral commissurotomy (PTMC); however, the short-term benefit has not been defined.


OBJECTIVE
To estimate the resolution rate of left atrial thrombus among PTMC candidates after 6 months of oral anticoagulation and to determine its main predictors.


METHODS
Prospective cohort.


METHODS
Community-based university medical center.


METHODS
219 PTMC candidates with thrombus demonstrated by multiplane transesophageal echocardiographic studies.


METHODS
The primary outcome was the status of the thrombus at the first 6-month follow-up; secondary measures were bleeding or thromboembolic complications.


RESULTS
Among 219 PTMC candidates with left atrial thrombus (mean age [+/-SD], 39.6 +/- 7.4 years [range, 19 to 62 years]), complete resolution of thrombus, with an overall disappearance rate of 24.2% (95% CI, 18.5% to 29.9%), was demonstrated in 53 patients who subsequently underwent successful PTMC. In another 166 patients, the thrombus size was reduced by 24% (P < 0.001). No thrombus resolution was observed in the 27 patients with a left atrial body thrombus. Eighteen patients had minor bleeding. The significant predictors of thrombus resolution were a New York Heart Association class of 2 or less, a left atrial appendage thrombus size of 1.6 cm2 or less, a left atrial spontaneous echocardiographic contrast grade of 1 or less, and an international normalized ratio (INR) of at least 2.5. Patients with all of these predictors had a 94.4% chance of complete thrombus resolution (CI, 84.4% to 98.1%).


CONCLUSIONS
After 6 months of oral anticoagulation, the left atrial thrombus disappeared in about a quarter of PTMC candidates so they could safely undergo PTMC. Less clinical severity, lower grading of the left atrial spontaneous echocardiographic contrast, a smaller thrombus, and a higher INR level predict thrombus resolution.
Silaruks
Songkwan
S
Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. sonsil@kku.ac.th
Thinkhamrop
Bandit
B
Kiatchoosakun
Songsak
S
Wongvipaporn
Chaiyasith
C
Tatsanavivat
Pyatat
P
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002404:Catheterization; D004334:Drug Administration Schedule; D017548:Echocardiography, Transesophageal; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D011446:Prospective Studies; D013927:Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000925:Anticoagulants