• Agnieszka Ciba-Stemplewska, Iwona Gorczyca-Głowacka, Agnieszka Kapłon-Cieślicka, Beata Uziębło-Życzkowska, Monika Budnik, Monika Gawałko, Paweł Krzesiński, Agnieszka Jurek, Piotr Scisło, Krzysztof J Filipiak, Grzegorz Opolski, and Beata Wożakowska-Kapłon.
• Department of Internal Medicine, Integrated Provincial Hospital, Kielce, Poland
• Pol. Arch. Med. Wewn. 2022 Sep 26; 132 (9).

IntroductionSome patients with atrial fibrillation (AF) develop left atrial appendage thrombus (LAAT) despite receiving anticoagulant treatment. Different scores were proposed to evaluate thromboembolic risk in patients with AF. Risk stratification according to sex is common in clinical practice.ObjectiveWe aimed to identify predictors of LAAT separately in men and women treated with dabigatran or rivaroxaban.Patients And MethodsThis retrospective study included 1256 patients (479 women [38.1%]) with AF who underwent transesophageal echocardiography before electrical cardioversion or catheter ablation, between January 2013 and December 2019, and received dabigatran or rivaroxaban for at least 3 weeks.ResultsMultivariable logistic regression analysis revealed nonparoxysmal AF to predict LAAT in women (odds ratio [OR], 9.70; P = 0.002). In men, the predictors were heart failure (OR, 4.14; P = 0.001), diabetes (OR, 2.64; P = 0.002), nonparoxysmal AF (OR, 5.61; P = 0.02), and estimated glomerular filtration rate below 60 ml/min/1.73 m2 (OR, 2.77; P = 0.01). In the receiver operating characteristic curve analysis, the CHA2DS2‑VASc-RAF score had the highest value for predicting LAAT in women (area under the curve [AUC] = 0.786). In men, CHA2DS2‑VASc-RAF, CHA2DS2, CHA2DS2‑VASc, and R2CHADS2 had sufficient predictive value (AUC = 0.786, 0.726, 0.734, and 0.780, respectively).ConclusionsThe predictors of LAAT differ between men and women treated with dabigatran or rivaroxaban. In women, the CHA2DS2‑VASc‑RAF score had the highest predictive value, while in men all the scores had equally sufficient predictive value.

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