Influence of renal function and dose of non-vitamin K antagonist oral anticoagulants on left atrial thrombus risk in patients with atrial fibrillation. Results from the multicenter LATTEE study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Renal dysfunction increases thromboembolic risk but is not consistently included in standard risk scores. AIMS: To compare the prevalence of left atrial thrombus (LAT) in atrial fibrillation (AF)/atrial flutter (AFl) patients based on renal function and oral anticoagulant (OAC) regimens. METHODS: Consecutive AF/AFl patients undergoing transesophageal echocardiography before cardioversion or ablation were included. RESULTS: Among 2790 patients with creatinine clearance (CrCl) data, 89% had CrCl ≥50 ml/min, 9.6% had CrCl 30-49 ml/min, and 1.5% had CrCl <30 ml/min. LAT prevalence was 6.7%, 16%, and 19%, respectively (P = 0.008). CrCl <50 ml/min was an independent predictor of LAT (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.25-2.64). Of 2028 patients treated with non-vitamin K antagonist OACs (NOACs), 17% received reduced doses, with 56% of these reductions deemed inappropriate. LAT prevalence was higher with reduced NOAC doses (12%) compared to standard doses (4.6%; P <0.001). Patients with no indication for dose reduction but receiving reduced doses had a higher LAT risk (12% vs. 4.2%; P <0.001). Among those with an indication for reduced doses, LAT prevalence was similar (11%) regardless of dose appropriateness. There were no significant differences in LAT prevalence among different NOACs. Inappropriate NOAC dosing increased LAT risk (OR, 1.74; 95% CI, 1.11-2.73). Inappropriate dose reductions, especially with apixaban and rivaroxaban, were the main issue in inappropriate NOAC prescribing, likely influenced by age, bleeding risk, anemia, low CrCl, and antiplatelet use. CONCLUSIONS: AF patients with CrCl <50 ml/min face a doubled LAT risk despite OAC therapy. Inappropriate NOAC dosing, particularly with apixaban and rivaroxaban, leads to double LAT risk.
Source: Kardiologia Polska
Authors: Monika Gawałko, Monika Budnik, Piotr Scisło, Radosław Piątkowski, Beata Uziębło-Życzkowska, Paweł Krzesiński, Katarzyna Starzyk, Beata Wożakowska-Kapłon, Ludmiła Daniłowicz-Szymanowicz, Damian Kaufmann, Maciej Wójcik, Robert Błaszczyk, Konrad Pieszko, Katarzyna Łojewska, Jarosław Hiczkiewicz, Maciej Wybraniec, Katarzyna Mizia-Stec, Katarzyna Kosmalska, Marcin Fijałkowski, Anna Szymańska, Mirosław Dłużniewski, Maciej Haberka, Michał Kucio, Błażej Michalski, Karolina Kupczyńska, Anna Tomaszuk-Kazberuk, Katarzyna Wilk-Śledziewska, Renata Wachnicka-Truty, Marek Koziński, Paweł Burchardt, Marcin Grabowski, Agnieszka Kapłon-Cieślicka
Institutions: Royal Adelaide Hospital, Medical University of Warsaw, The University of Adelaide, Jan Kochanowski University, Gdańsk Medical University, Medical University of Lublin, University of Zielona Góra, Medical University of Silesia, ERN GUARD-Heart, Medical University of Lodz, Medical University of Białystok, Poznan University of Medical Sciences
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7117694747