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

Clinical research in cardiology : official journal of the German Cardiac Society

Authors: Vivian Vij, Kerstin Piayda, Dominik Nelles, Steffen Gloekler, Roberto Galea, Monika Fürholz, Bernhard Meier, Marco Valgimigli, Gilles O'Hara, Dabit Arzamendi, Victor Agudelo, Lluis Asmarats, Xavier Freixa, Eduardo Flores-Umanzor, Ole De Backer, Lars Sondergaard, Luis Nombela-Franco, Angela McInerney, Kasper Korsholm, Jens Erik Nielsen-Kudsk, Shazia Afzal, Tobias Zeus, Felix Operhalski, Boris Schmidt, Gilles Montalescot, Paul Guedeney, Xavier Iriart, Noelie Miton, Jacqueline Saw, Thomas Gilhofer, Laurent Fauchier, Egzon Veliqi, Felix Meincke, Nils Petri, Peter Nordbeck, Dmitrii Ognerubov, Evgeny Merkulov, Ignacio Cruz-González, Rocio Gonzalez-Ferreiro, Deepak L Bhatt, Alessandra Laricchia, Antonio Mangieri, Heyder Omran, Jan Wilko Schrickel, Josep Rodes-Cabau, Horst Sievert, Georg Nickenig, Alexander Sedaghat

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.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

PMID: 35849156

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