Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an analysis from the multicenter EUROC-DRT registry

Clin Res Cardiol. 2022 Nov;111(11):1276-1285. doi: 10.1007/s00392-022-02065-4. Epub 2022 Jul 18.

Abstract

Background: Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry.

Methods: We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics.

Results: Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5% vs. 81.5%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1% vs. 16.7%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5% vs. 3.8%, Hazard Ratio: 4.21 [95%-confidence interval: 1.88-9.49], p < 0.01).

Conclusions: DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.

Keywords: Atrial fibrillation; Device-related thrombus; Left atrial appendage closure; Stroke.

Publication types

  • Multicenter Study

MeSH terms

  • Anticoagulants / therapeutic use
  • Atrial Appendage* / diagnostic imaging
  • Atrial Appendage* / surgery
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / surgery
  • Echocardiography
  • Humans
  • Ischemic Attack, Transient*
  • Registries
  • Risk Factors
  • Stroke* / diagnosis
  • Stroke* / epidemiology
  • Stroke* / etiology
  • Thrombosis* / diagnosis
  • Thrombosis* / epidemiology
  • Thrombosis* / etiology
  • Treatment Outcome

Substances

  • Anticoagulants