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

• DOI: 10.1007/s00392-022-02065-4
• Publication Date: 2022-07-18T04:02:56Z
• 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-Um...; Ole De Backer; Lars Sondergaard; Luis Nombela-Franco; Angela McInerney; Kasper Korsholm; Jens Erik Nielsen...; 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-Gonz...; Rocio Gonzalez-Fe...; Deepak L. Bhatt; Alessandra Laricchia; Antonio Mangieri; Heyder Omran; Jan Wilko Schrickel; Josep Rodes-Cabau; Horst Sievert; Georg Nickenig; Alexander Sedaghat
• Keywords: Appendage; Closure (psychology)

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