A total of 198 patients from 299 institutions underwent transesophageal echocardiography (TEE) to rule out LA
thrombus before ECV. Of these, LA
thrombus was found in eight patients (4%), who tended to be older (67.3 vs. 61.3 years, p=0.175), had higher CHADS2 scores (1.88 vs. 0.95, p=0.058), and a higher prevalence of prior
stroke or
transient ischemic attack (22.2% vs. 2.6%, p=0.034) than those without LA
thrombus. Of the eight patients with LA
thrombus, one had LA
thrombus during a
Dabi 150 mg b.i.d treatment, whereas the remaining seven were receiving 110 mg b.i.d for 3 weeks or longer. In 6 of the 8 patients with LA
thrombus, a second TEE was performed, revealing complete resolution of LA
thrombus in five; among these five patients, one received
Dabi dosage of 150 mg b.i.d unchanged, two received an increased dosage from 110 mg to 150 mg b.i.d, and two were switched to
warfarin. Two patients had a
stroke 3 and 15 days after ECV, and one had a major large intestine
bleeding episode during
Dabi therapy.
CONCLUSIONS: LA
thrombus developed in 4% of patients with AF receiving
Dabi. Older patients with a higher CHADS2 score receiving a lower
Dabi dosage were more likely to develop LA
thrombus, which was resolved with a prolonged or increased dosage. A higher
Dabi dosage may be more beneficial before ECV but prospective randomized studies would be needed to confirm these results.