Abstract 14308: Dabigratan Has a Higher Risk of Left Atrial Appendage Thrombus Formation in Patients With Af When Compared to Warfarin and Rivaroxaban
Introduction: Transesophageal echocardiography (TEE) has been demonstrated to be a sensitive tool to detect left atrial thrombi in patients with AF before electrical cardioversion or before AF ablation We sought to determine the prevalence of LAA thrombi before electrical cardioversion in patients treated with different oral anticoagulants.
Methods: 487 consecutive patients with AF undergoing TEE before electrical cardioversion or before AF ablation have been enrolled in this study. Based on the oral anticoagulant used before TEE, patients were divided into three groups: patients undergoing TEE while on warfarin (group I, n=209), patients undergoing TEE while on dabigratan 150 mg (group II, n=149) and patients undergoing TEE while on Rivaroxaban (group III, n=129). All patients had to be on their OAT for at least 30 days before TEE. The prevalence of left atrial thrombi were collected and analyzed.
Results: No baseline differences were observed between groups. Prevalence of positive TEE for left atrial thrombi was 0.96% (2/209 pts) in group I, 6.7% (10/149) in group II and 0.78% (1/129) in group III (p=0.002). After adjusting for potential risk factors in multivariate logistic model, non-paroxysmal AF was a predictor of positive TEE (odds ratio 3.01, 95% CI 1.4 to 6.5, p=0.005). When stratified by type of anticoagulation, dabigatran use had 4.6 times higher likelihood for LAA thrombi compared to warfarin (OR 4.6 (1.6 to 21), p=0.003) and 6.2 times compared to Rivaroxaban (OR 6.2 (1.9 to 31), p=0.002). The area under the receiver operating characteristic curve (AUC) demonstrated fair discriminatory ability of the model (AUC 0.72, 95% CI 0.59 to 0.85).
Conclusion: The results of our study show that anticoagulation with dabigratan 150mg is associated with a higher prevalence of left atrial thrombus as assessed by TEE when compared to Warfarin and Rivaroxaban.
- © 2013 by American Heart Association, Inc.