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Prevalence of LA thrombus despite guideline directed anticoagulation – results from a meta-analysis

Taken directly from the American College of Cardiology 
A summary by Sarah Kohnstamm, MD, FACC

Quick Takes

  • This meta-analysis set out to answer the prevalence of LA thrombus in patients with atrial fibrillation or flutter on guideline-directed anticoagulation. It further identified higher-risk populations in whom the diagnostic yield of a pre-procedure TEE would be beneficial.
  • The overall prevalence of LA thrombus in patients with atrial fibrillation or flutter, receiving a minimum of 3 weeks of uninterrupted anticoagulation, was approximately 3%.
  • The prevalence of LA thrombus was even higher in patients with nonparoxysmal atrial fibrillation or flutter (6.3%), CHA2DS2-VASc score ≥3 (4.81%), and those undergoing cardioversion (5.55%) as opposed to ablation.

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Editorial Comment: 

Lurie A, Wang J, Hinnegan KJ, McIntyre WF, Belley-Côté EP, Amit G, Healey JS, Connolly SJ, Wong JA. Prevalence of Left Atrial Thrombus in Anticoagulated Patients With Atrial Fibrillation. J Am Coll Cardiol. 2021 Jun 15;77(23):2875-2886. doi: 10.1016/j.jacc.2021.04.036. PMID: 34112315.