ArticleClinical research in cardiology : official journal of the German Cardiac Society2026
Comparative analysis of therapeutic strategies in atrial fibrillation patients with left atrial appendage thrombus despite optimal NOAC therapy.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Comparison of therapeutic strategies in patients presenting with left atrial thrombus despite oral anticoagulation.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Comparative efficacy and safety of anticoagulant, combination, and antiplatelet therapies in patients with intracardiac thrombus: a real-world retrospective study.Frontiers in medicine · 2026Article
- Overcoming NOAC-resistant left atrial appendage thrombus in atrial fibrillation: clinical gaps and therapeutic insights.Frontiers in cardiovascular medicine · 2025Review
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19 authors.
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Abstract
BACKGROUND AND
aimsLeft atrial appendage (LAA) thrombus is the primary cause of stroke and systemic embolism in atrial fibrillation (AF). Non-vitamin-K oral anticoagulants (NOACs) effectively reduce LAA thrombus prevalence and stroke risk. However, the optimal treatment of a NOAC-resistant thrombus remains unclear. We aimed to evaluate therapeutic strategies for resolving LAA thrombus in patients on optimal NOAC therapy.
methodsWe retrospectively analyzed patients scheduled for cardioversion or catheter ablation of AF between 2014 and 2023 with LAA thrombus on transesophageal echocardiography (TEE) despite being on optimal NOAC therapy. We assessed how the applied management strategy affected thrombus resolution.
resultsAmong the analyzed 120 patients, a change to a different NOAC occurred in 41% of cases, a transition to a VKA in 30%, and the supplementation with antiplatelet therapy in 11%. In contrast, 18% of the patients received unchanged therapy. Follow-up imaging at 65 [44 - 95] days showed successful thrombus resolution in 92 (77%) of cases, predicted by a lower CHA2DS2-VASc score (p = 0.01). Any modification of antithrombotic therapy was an independent predictor of thrombus resolution (OR 5.28 [1.55-18], p = 0.01). Of the four strategies, there was a trend toward better thrombus resolution with switching to a VKA (OR 3.23 [1.03-10.1], p = 0.04).
conclusionResolution of LAA thrombus in patients already on adequate NOAC treatment may require a revision of the anticoagulation strategy. In addition, transitioning from NOAC to VKA might be considered.
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