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Prevalence and Clinical Determinants of Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation Prior to Pulmonary Vein Isolation
The CHADS2 score is considered a reliable predictor of stroke/thromboembolism risk in patients with atrial fibrillation (AF). However, thromboembolism can occasionally occur even in AF patients with low CHADS2 score (CHADS2 score = 0 or 1). To investigate the incidence and predictors of left atrial appendage (LAA) thrombus (LAAT) formation in patients with AF, we studied consecutive 543 Japanese AF patients who underwent transesophageal echocardiography before pulmonary vein isolation from 2008 to 2012.
Source: The American Journal of Cardiology - August 13, 2015 Category: Cardiology Authors: Makiko Nishikii-Tachibana, Nobuyuki Murakoshi, Yoshihiro Seo, DongZhu Xu, Masayoshi Yamamoto, Tomoko Ishizu, Akiko Atsumi, Tomoko Machino-Ohtsuka, Kenji Kuroki, Hiro Yamasaki, Miyako Igarashi, Yukio Sekiguchi, Kazutaka Aonuma Source Type: research

Treatment of Massive or Submassive Acute Pulmonary Embolism with Catheter Directed Thrombolysis
The presentation of acute pulmonary thromboembolism (PE) can be highly variable resulting in diagnostic challenges and management difficulties. Current guidelines suggest that therapy must be adjusted based on the severity of PE presentation. Systemic thrombolysis is the standard therapy for acute massive pulmonary embolism (PE), however systemic thrombolysis carries an estimated 20% risk of major hemorrhage, including a 3%-5% risk of hemorrhagic stroke. There are data supporting the use of catheter directed therapy (CDT) in massive and sub-massive PE, but past studies have limited its use to patients in whom systemic thro...
Source: The American Journal of Cardiology - December 31, 2015 Category: Cardiology Authors: Ashraf Mostafa, Alexandros Briasoulis, Tesfaye Telila, Kevin Belgrave, Cindy Grines Source Type: research

Treatment of Massive or Submassive Acute Pulmonary Embolism With Catheter-Directed Thrombolysis
The presentation of acute pulmonary thromboembolism (PE) can be highly variable resulting in diagnostic challenges and management difficulties. Current guidelines suggest that therapy must be adjusted based on the severity of PE presentation. Systemic thrombolysis is the standard therapy for acute massive PE; however, systemic thrombolysis carries an estimated 20% risk of major hemorrhage, including a 3% to 5% risk of hemorrhagic stroke. There are data supporting the use of catheter-directed therapy (CDT) in massive and submassive PE, but past studies have limited its use to patients in whom systemic thrombolysis has eithe...
Source: The American Journal of Cardiology - December 31, 2015 Category: Cardiology Authors: Ashraf Mostafa, Alexandros Briasoulis, Tesfaye Telila, Kevin Belgrave, Cindy Grines Tags: Review Source Type: research

Assessment of Device Related Thrombus and Associated Clinical Outcomes with the WATCHMAN Left Atrial Appendage Closure Device for Embolic Protection in Patients with Atrial Fibrillation (From the PROTECT-AF Trial)
Left atrial appendage (LAA) closure with the WATCHMAN device is an alternative to anticoagulation for stroke prevention in selected patients with atrial fibrillation (AF). LA device related thrombus (DRT) is poorly defined and understood. We aimed to 1) develop consensus echocardiographic diagnostic criteria for DRT 2) estimate the incidence of DRT and 3) determine clinical event rates in patients with DRT. In Phase 1 (Training), a training manual was developed and reviewed by 3 echocardiographers with LAA closure device experience.
Source: The American Journal of Cardiology - February 1, 2016 Category: Cardiology Authors: Michael L. Main, Dali Fan, Vivek Y. Reddy, David R. Holmes, Nicole T. Gordon, Tina R. Coggins, John A. House, Lawrence Liao, Dawn Rabineau, George G. Latus, Kenneth C. Huber, Horst Sievert, Richard F. Wright, Shephal K. Doshi, Pamela S. Douglas Source Type: research

Assessment of Device-Related Thrombus and Associated Clinical Outcomes With the WATCHMAN Left Atrial Appendage Closure Device for Embolic Protection in Patients With Atrial Fibrillation (from the PROTECT-AF Trial)
Left atrial appendage closure with the WATCHMAN device is an alternative to anticoagulation for stroke prevention in selected patients with atrial fibrillation (AF). LA device-related thrombus (DRT) is poorly defined and understood. We aimed to (1) develop consensus echocardiographic diagnostic criteria for DRT; (2) estimate the incidence of DRT; and (3) determine clinical event rates in patients with DRT. In phase 1 (training), a training manual was developed and reviewed by 3 echocardiographers with left atrial appendage closure device experience.
Source: The American Journal of Cardiology - February 1, 2016 Category: Cardiology Authors: Michael L. Main, Dali Fan, Vivek Y. Reddy, David R. Holmes, Nicole T. Gordon, Tina R. Coggins, John A. House, Lawrence Liao, Dawn Rabineau, George G. Latus, Kenneth C. Huber, Horst Sievert, Richard F. Wright, Shephal K. Doshi, Pamela S. Douglas Tags: Arrhythmias and Conduction Disturbances Source Type: research

Long-Term Population-Based Cerebral Ischemic Event and Cognitive Outcomes of Direct Oral Anticoagulants Compared to Warfarin among Long-Term Anticoagulated Patients for Atrial Fibrillation
Direct oral anticoagulants (DOACs) have been used in clinical practice in the US for the last 4-6 years. While DOACs may be an attractive alternative to warfarin among many patients, long-term outcomes of use of these medications are unknown. We performed a propensity-matched analysis to report patient important outcomes of death, stroke/TIA, bleeding, major bleeding and dementia among patients taking a DOAC or warfarin. Patients receiving long-term anticoagulation between June 2010-December 2014 for thromboembolism prevention with either warfarin or a DOAC were matched 1:1 by index date and propensity score.
Source: The American Journal of Cardiology - May 4, 2016 Category: Cardiology Authors: Victoria Jacobs, Heidi T. May, Tami L. Bair, Brian G. Crandall, Michael J. Cutler, John D. Day, Charles Mallender, Jeffrey S. Osborn, Scott M. Stevens, J. Peter Weiss, Scott C. Woller, T. Jared Bunch Source Type: research

Management of Major Bleeding in Patients With Atrial Fibrillation Treated With Non –Vitamin K Antagonist Oral Anticoagulants Compared With Warfarin in Clinical Practice (from Phase II of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation ORBIT-AF II)
Non –vitamin K antagonist oral anticoagulants (NOACs) are effective at preventing stroke in patients with atrial fibrillation (AF). However, little is known about the management of bleeding in contemporary, clinical use of NOACs. We aimed to assess the frequency, management, and outcomes of major blee ding in the setting of community use of NOACs. Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry, we analyzed rates of International Society on Thrombosis and Haemostasis major bleeding and subsequent outcomes in patients treated with NOACs versus warfarin.
Source: The American Journal of Cardiology - February 28, 2017 Category: Cardiology Authors: Benjamin A. Steinberg, DaJuanicia N. Simon, Laine Thomas, Jack Ansell, Gregg C. Fonarow, Bernard J. Gersh, Peter R. Kowey, Kenneth W. Mahaffey, Eric D. Peterson, Jonathan P. Piccini, Outcomes Registry for Better Informed Treatment of Atrial Fibrillation ( Tags: Arrhythmias and Conduction Disturbances Source Type: research

Usefulness of the CHA2DS2-VASc Score to Predict Mortality in Defibrillator Recipients
In this study, we examined data from 2,258 patients who underwent ICD device implantation at the hospitals of the University of Pittsburgh Medical Center from February 2002 to April 2014 (median follow up 5.1 years) and examined the impact of their CHA2DS2-VASC score at the time of device implantation on all-cause mortality.
Source: The American Journal of Cardiology - April 13, 2017 Category: Cardiology Authors: Christopher Hong, Krishna Alluri, Nasir Shariff, Furqan Khattak, Evan Adelstein, Sandeep Jain, Samir Saba Source Type: research

Outcome of Patients Receiving Thrombolytic Therapy While on Rivaroxaban for Non-Valvular Atrial Fibrillation (From ROCKET AF)
The safety of intravenous thrombolysis in patients taking rivaroxaban has not been well established. We retrospectively analyzed the outcomes of all patients who received thrombolytic therapy in the ROCKET AF trial. Review of medical and adverse event records for patients receiving thrombolytic therapy while enrolled in ROCKET AF was performed to determine their baseline characteristics, indications for thrombolysis, and type of agent used. Safety endpoints were 30-day post-thrombolytic rates of stroke, bleeding, and mortality.
Source: The American Journal of Cardiology - August 7, 2017 Category: Cardiology Authors: Sean T Chen, Anne S Hellkamp, Richard C Becker, Scott D Berkowitz, G ünter Breithardt, Keith AA Fox, Werner Hacke, Jonathan L Halperin, Graeme J Hankey, Kenneth W Mahaffey, Christopher C Nessel, Jonathan P Piccini, Daniel E Singer, Manesh R Patel Source Type: research

Usefulness of the 2MACE Score to Predicts Adverse Cardiovascular Events in Patients with Atrial Fibrillation.
We investigated the incidence of non-embolic adverse events in 2 cohorts of AF patients and validated the 2MACE score [(metabolic syndrome, age ≥75) [doubled]; (myocardial infarction (MI)/revascularization, congestive heart failure (HF) and stroke/TIA/thromboembolism)] as predictor of major adverse cardiovascular events (MACEs). We recruited 2630 AF patients from two different cohorts (Murcia AF and FANTASIIA). The 2MACE score was calcula ted and during a median of 7.2 years (Murcia AF cohort) and 1.01 years (FANTASIIA) of follow-up we recorded all non-embolic adverse events and MACEs (composite of non-fatal MI/revascula...
Source: The American Journal of Cardiology - September 18, 2017 Category: Cardiology Authors: Jos é Miguel Rivera-Caravaca, Francisco Marín, María Asunción Esteve-Pastor, Paula Raña-Míguez, Manuel Anguita, Javier Muñiz, Ángel Cequier, Vicente Bertomeu-Martínez, Mariano Valdés, Vicente Vicente, Gregory Yoke Hong Lip, Vanessa Roldán Source Type: research

Real-Time Pathophysiologic Correlates of Left Atrial Appendage Thrombus in Patients Undergoing Transesophageal-Guided Electrical Cardioversion for Atrial Fibrillation
Although current guidelines advocate using the CHA2DS2-VASc score to assess the risk of stroke in patients with atrial fibrillation (AF), compared with transesophageal echocardiographic (TEE), its ability to predict left atrial appendage thrombus (LAAT) is limited. We studied 3,324 consecutive patients with sustained AF from our prospective registry of patients undergoing first-time TEE-guided electrical cardioversion (ECV) from May 2000 through March 2012. The association of CHA2DS2-VASc score or TEE risk factors with the occurrence of LAAT was analyzed.
Source: The American Journal of Cardiology - March 13, 2018 Category: Cardiology Authors: Rowlens M. Melduni, Bernard J. Gersh, Waldemar E. Wysokinski, Naser M. Ammash, Paul A. Friedman, David O. Hodge, Krishnaswamy Chandrasekaran, Jae K. Oh, Hon-Chi Lee Source Type: research

Real-Time Pathophysiologic Correlates of Left Atrial Appendage Thrombus in Patients Who Underwent Transesophageal-Guided Electrical Cardioversion for Atrial Fibrillation
Although current guidelines advocate using the CHA2DS2-VASc score to assess the risk of stroke in patients with atrial fibrillation (AF), compared with transesophageal echocardiography (TEE), its ability to predict left atrial appendage thrombus (LAAT) is limited. We studied 3,324 consecutive patients with sustained AF from our prospective registry of patients who underwent first-time TEE-guided electrical cardioversion (ECV) from May 2000 through March 2012. The association of CHA2DS2-VASc score or TEE risk factors with the occurrence of LAAT was analyzed.
Source: The American Journal of Cardiology - March 13, 2018 Category: Cardiology Authors: Rowlens M. Melduni, Bernard J. Gersh, Waldemar E. Wysokinski, Naser M. Ammash, Paul A. Friedman, David O. Hodge, Krishnaswamy Chandrasekaran, Jae K. Oh, Hon-Chi Lee Source Type: research

Usefulness and Safety of Rivaroxaban in Patients Following Isolated Mitral Valve Replacement With A Mechanical Prosthesis
Rivaroxaban has previously been tested in experimental and animal models with encouraging results. We prospectively selected 7 patients between May 2017 and January 2018 who underwent isolated mitral valve replacement with a mechanic prosthesis and had unstable INR control at least 3 months after surgery. An intervention of rivaroxaban 15 mg was then administered twice daily for a period of 90 days. No patient presented intracardiac thrombus, reversible ischemic neurological deficit, ischemic or hemorrhagic stroke, hospitalization or death during 3 months of follow-up.
Source: The American Journal of Cardiology - July 15, 2018 Category: Cardiology Authors: Andr é R Durães, Yasmin de S L Bitar, Maria Luiza G Lima, Caroline C Santos, Igor S Schonhofen, José Admirço L Filho, Leonardo Roever Source Type: research

Prevalence and Resolution of Left Atrial Thrombus in Patients With Nonvalvular Atrial Fibrillation and Flutter With Oral Anticoagulation
This study sought to establish 1) the prevalence of LAA thrombus 2) the prevalence of LAA thrombus despite antithrombotic therapy, 3) the rate of persistence of LAA thrombus despite appropriate anticoagulant prescriptions, and 4) determinants of LAA thrombus persistence.
Source: The American Journal of Cardiology - September 26, 2018 Category: Cardiology Authors: Adam D Niku, Takahiro Shiota, Robert J Siegel, Florian Rader Source Type: research

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