Samra Yasmin, Azmat Ehsan Qureshi, Ahmed Noeman.
Left atrial/left atrial appendage thrombus in patients with rheumatic mitral stenosis despite adequate anticoagulation.
J Cardiovascular Dis Jan ;10(4):97-100.

Background: Background: Anticoagulation is the main stay of therapy for patients suffering from rheumatic mitral Background: stenosis along-with atrial fibrillation and dilated left atrium. How much effective this strategy is in preventing thrombus formation is unclear. The objective of this study was to see the frequency of left atrial/left atrial appendage thrombus in this patient population in the presence of adequate anticoagulation. Methods: This cross-sectional study was done at the department of Cardiology, Punjab Institute of Methods Cardiology Lahore, Pakistan from January 2012 to August 2012. One hundred patients presenting with symptomatic, pliable moderate to severe rheumatic mitral stenosis with atrial fibrillation and dilated left atrium and having adequate anticoagulation (INR > 2.0 for at least 3 months) were subjected to transesophageal echocardiography (TEE) with the intent of doing early balloon mitral valvotomy. Patients were divided into “No Thrombus” and “Thrombus” groups depending upon absence or presence of LA/LAA thrombus respectively and clinical characteristics of both groups were compared. Results: Out of 100 patients, 44(44%) had thrombus in LA or LAA. Thirty seven had only LAA : thrombus while 06 had LA thrombus along with LAA thrombus. One patient had LA thrombus only. Thrombus was more common with increasing age (p=0.002). There was no difference between two groups regarding mitral valve area, significant regurgitations (mitral, aortic or tricuspid), dilated right heart and pulmonary hypertension. Conclusions: Conclusions: Frequency of Left atrial/left atrial appendage thrombus still remains high in patients with Conclusions: rheumatic mitral stenosis having atrial fibrillation and dilated left atrium in spite of adequate anticoagulation and this frequency increases with increasing age. Keywords: Keywords: Rheumatic mitral stenosis, atrial fibrillation, left atrial / left atrial appendage thrombus, Keywords: anticoagulation.

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