Prevalence and clinical characteristics associated with left atrial thrombus detection: Apixaban

Table 1 Cardiac risk factors and echocardiographic characteristics by presence of thrombus

	Study population (n = 226)	Apixaban-thrombus ( n = 7)	Apixaban - no thrombus ( n = 219)	P-value1
Age	65.8 ± 11.9	68.1 ± 8.0	65.7 ± 11.9	0.458
Race
White	190 (84.1)	4 (57.1)	186 (84.9)	0.0825
Black	34 (15.0)	3 (42.9)	31 (14.2)	0.0712
Hispanic	0 (0)	0 (0)	0 (0)	-
Asian	2 (0.9)	0 (0)	2 (0.9)	1
Most recent Cr	1.01 ± 0.33	1.18 ± 0.82	1.01 ± 0.32	0.662
ESRD	6 (2.7)	2 (28.5)	4 (1.8)	0.012
Clopidogrel	7 (3.1)	0 (0)	7 (3.2)	1
Aspirin	83 (36.7)	2 (28.5)	81 (37.0)	1
CHA2DS2-VASc	2.83 ± 1.62	3.43 ± 1.40	2.81 ± 1.62	0.354
CHF	88 (34.5)	3 (42.9)	75 (34.2)	0.695
Hypertension	184 (81.4)	7 (100)	177 (80.8)	0.353
Age > 75	50 (22.1)	1 (14.3)	49 (22.4)	1
Diabetes	50 (22.1)	2 (28.5)	48 (21.9)	0.652
Stroke	11 (4.9)	0 (0)	11 (5.0)	1
Vascular disease	26 (11.5)	1 (14.3)	25 (11.4)	0.580
Age > 65	145 (64.2)	6 (85.7)	139 (63.5)	0.426
Female	87 (38.5)	2 (28.5)	85 (38.8)	0.710
Persistent AF	59 (26.1)	5 (71.4)	54 (24.7)	0.014
Echocardiographic data
LVEF	47.8 ± 14.3	38.6 ± 19.3	48.1 ± 14.1	0.241
LVEF < 30	33 (14.6)	3 (42.9)	30 (13.7)	0.066
LVEF 30-49	44 (19.5)	1 (14.3)	43 (19.6)	1
LVEF ≥ 50	149 (65.9)	3 (42.9)	146 (66.7)	0.233
LAA velocity	48.4 ± 18.1	27.8 ± 10.5	49.0 ± 18.0	0.001
LAA velocity < 40 cm/s	71 (31.4)	6 (85.7)	65 (29.7)	0.004
SEC classification
None	206 (91.2)	1 (14.3)	205 (93.6)	<0.001
Clearing	7 (3.1)	1 (14.3)	6 (2.7)	0.200
Dense	13 (5.8)	5 (71.4)	8 (3.7)	<0.001
LA dilation
Moderate	66 (29.2)	1 (14.3)	65 (29.7)	0.677
Severe	59 (26.1)	6 (85.7)	53 (24.2)	0.001
Mitral Regurgitation
Moderate	53 (23.5)	1 (14.3)	52 (23.7)	1
Severe	5 (2.2)	1 (14.3)	4 (1.8)	0.147

¹P-values denote differences between cohorts with and without thrombus. AF: Atrial fibrillation; CHF: Congestive heart failure; Cr: Creatinine; ESRD: End-stage renal disease; LA: Left atria; LAA: Left atrial appendage; LVEF: Left ventricular ejection fraction; SEC: Spontaneous echo contrast.

Table 2 Univariate and multivariate predictors of left atrial appendage thrombus

Apixaban
Variable	Unadjusted (univariate analysis)			Adjusted (multivariate analysis)
	OR	95%CI	P-value	OR	95%CI	P-value
CHF	1.440	0.31-6.60	0.6388
Hypertension	1.933	0.24-15.87	0.5396
Age > 65	3.453	0.41-29.20	0.2552
Age > 75	0.578	0.07-4.92	0.6160
Diabetes	1.425	0.27-7.58	0.6778
Stroke	2.177	0.25-18.85	0.4800
Vascular disease	1.293	0.15-11.19	0.8152
CHA2DS2-VASc	1.261	0.80-2.00	0.3240
Gender (female)	0.631	0.12-3.32	0.5866
Persistent AF	7.639	1.44-40.51	0.01691	7.427	1.02-53.92	0.0474
LVEF < 30%	4.725	1.01-22.17	0.04891	0.726	0.10-5.12	0.7480
LVEF < 50%2	2.667	0.58-12.23	0.2069
Severe left atrial dilation1	8.877	1.27-61.85	0.02751	5.901	0.69-50.62	0.1054
LAA velocity (decrease)1	1.110	1.031-1.19	0.00321	1.086	1.010-1.187	0.0489
LAA velocity < 40 cm/s2	14.215	1.68-120.40	0.01492

¹Significant factor in the univariate model which is used in the multivariate model;

²Significant factor in the univariate model but not considered in the multivariate model. AF: Atrial fibrillation; CHF: Congestive heart failure; CI: Confidence interval; LAA: Left atrial appendage; LVEF: Left ventricular ejection fraction; OR: Odds ratio.

Table 3 Clinical characteristics and thrombus resolution

Study ID	AC after thrombus identification	Thrombus resolution	Duration of AC (d)	P2Y12 inhibitor	Aspirin	LVEF (%)	LA dilation	Spontaneous contrast	LAA velocity (cm/s)	Duration of A-fib	CHADS-VASc score
Apixaban following index TEE (n = 6)
LA-011	Apixaban	Yes	143	No	No	55	Moderate	None	30.4	Paroxysmal	3
LA-016	Apixaban	Yes	38	Yes	Yes	15	Severe	Severe	14.4	Paroxysmal	2
LA-017	Apixaban	Yes	175	No	Yes	15	Severe	Mild	34.0	Paroxysmal	4
LA-019	Apixaban	Yes	40	No	No	30	Severe	None	26.5	Paroxysmal	2
LA-020	Apixaban	Yes	56	No	Yes	25	Severe	Moderate	28.0	Persistent	3
LA-005	Apixaban	No	112	No	No	65	Moderate	Moderate	49.2	Persistent	4
		5/6	Mean 94.0
		(83.3%)	Median 84.0

AC: Anticoagulation; A-fib: Atrial fibrillation; LA: Left atrium; LAA: Left atrial appendage; LVEF: Left ventricular ejection fraction; TEE: Transesophageal echocardiogram.