{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:24:25Z","timestamp":1787199865879,"version":"build-2736575974"},"reference-count":43,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n To analyze the efficacy and safety of various anticoagulation strategies\/regimen used for managing thrombus or spontaneous echo contrast in the left atrial appendage.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Thrombus or spontaneous echo contrast in the left atrial appendage was detected via transesophageal echocardiography in 83 patients, most often during a stroke assessment. The chosen anticoagulants were compared, and follow\u2010up was conducted with repeated transesophageal echocardiograms.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Heparin and vitamin K antagonists (VKAs) were the most commonly selected treatment regimens. The initial resolution rate was approximately 30% across all treatment regimens after a follow\u2010up of 8\u00a0\u00b1\u00a08 weeks (DOACs 30%, VKAs 30%, heparin 25%,\n p<\/jats:italic>\n \u00a0 = \u00a00.9). Continuing the same protocol or switching to a direct oral anticoagulant (DOAC) were the main alternatives when the thrombus persisted after the first echocardiographic control. An additional 22% of patients with repeated controls experienced resolution after 23\u00a0\u00b1\u00a014 weeks of anticoagulant treatment. Major bleeding events were observed in 3% of patients.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Resolution of thrombi\/echo contrasts was noted in a significant proportion of patients with our management approach, without apparent significant differences between treatment regimens (difficult to interpret due to the low number of patients under DOACs). Bleeding complications remain significant.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pace.70404","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T03:53:12Z","timestamp":1787197992000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Left Atrial Appendage Thrombi and Spontaneous Echo Contrast"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5364-3021","authenticated-orcid":false,"given":"Timnou Bekouti","family":"Jean","sequence":"first","affiliation":[{"name":"Cardiology Department Dax\u2010C\u00f4te D'argent Hospital Center Dax France"},{"name":"Interventional Cardiology Center of Douala Douala Cameroon"},{"name":"Faculty of Medicine and Biomedical Sciences Yaound\u00e9 Cameroon"},{"name":"Cardiology Department Rangueil University Hospital Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravakiniaina Ranaivosoa","family":"Mialy","sequence":"additional","affiliation":[{"name":"Cardiology Department Dax\u2010C\u00f4te D'argent Hospital Center Dax France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ateba Ateba","family":"Nelly Stella","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmaceutical Sciences of Ebolowa Ebolowa Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsague Kegni","family":"Hermann","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Biomedical Sciences Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rambolarimanana","family":"Mansh","sequence":"additional","affiliation":[{"name":"Cardiology Department Dax\u2010C\u00f4te D'argent Hospital Center Dax France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ndobo","family":"Julia Val\u00e9rie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Biomedical Sciences Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imbey Eheth","family":"Levy","sequence":"additional","affiliation":[{"name":"Cardiology Department Rangueil University Hospital Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4800-1841","authenticated-orcid":false,"given":"Maury","family":"Philippe","sequence":"additional","affiliation":[{"name":"Cardiology Department Rangueil University Hospital Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diawara","family":"Alpha","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmaceutical Sciences of Ebolowa Ebolowa Cameroon"},{"name":"Neurology Department Dax\u2010C\u00f4te D'argent Hospital Center Dax France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roynard","family":"Jean Louis","sequence":"additional","affiliation":[{"name":"Cardiology Department Dax\u2010C\u00f4te D'argent Hospital Center Dax France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boombhi","family":"Jerome Hilaire","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Biomedical Sciences Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.3389\/fphys.2018.01938","article-title":"The Impact of Left Atrium Appendage Morphology on Stroke Risk Assessment in Atrial Fibrillation: A Computational Fluid Dynamics Study","volume":"9","author":"Masci A.","year":"2019","journal-title":"Frontiers in Physiology"},{"key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"511","DOI":"10.3390\/medicina55090511","article-title":"Diagnosis and Management of Left Atrium Appendage Thrombosis in Atrial Fibrillation Patients Undergoing Cardioversion","volume":"55","author":"Melillo E.","year":"2019","journal-title":"Medicina (Kaunas)"},{"key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/europace\/euz212","article-title":"The Left Atrial Appendage in Humans: Structure, Physiology and Pathogenesis","volume":"22","author":"Karim N.","year":"2020","journal-title":"Europace"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"R65","DOI":"10.1530\/ERP-18-0083","article-title":"Left Atrial Spontaneous Echo Contrast: Relationship With Clinical and Echocardiographic Parameters","volume":"6","author":"Ito T.","year":"2019","journal-title":"Echo Research and Practice"},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","DOI":"10.1038\/srep27650","article-title":"Intensity of Left Atrial Spontaneous Echo Contrast as a Correlate for Stroke Risk Stratification in Patients With Nonvalvular Atrial Fibrillation","volume":"6","author":"Zhao Y.","year":"2016","journal-title":"Scientific Reports"},{"key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","article-title":"ESC Scientific Document Group. 2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With EACTS","volume":"37","author":"Kirchhof P.","year":"2016","journal-title":"European Heart Journal"},{"key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1093\/europace\/euz257","article-title":"Diagnosis and Management of Left Atrial Appendage Thrombus in Patients With Atrial Fibrillation Undergoing Cardioversion or Percutaneous Left Atrial Procedures: Results of the European Heart Rhythm Association Survey","volume":"22","author":"Farkowski M. 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A Preliminary Study of 6 Cases","volume":"93","author":"Lab\u00e8que J. N.","year":"2000","journal-title":"Archives Des Maladies Du Coeur Et Des Vaisseaux"},{"key":"e_1_2_12_20_1","doi-asserted-by":"crossref","first-page":"e160","DOI":"10.1016\/j.jccase.2011.12.001","article-title":"Immediate Disapearance of Large Thrombus in Left Atrium Without Evidence of Systemic Embolization After Heparin Treatment","volume":"5","author":"Oishi G.","year":"2012","journal-title":"Journal of Cardiology Cases"},{"key":"e_1_2_12_21_1","doi-asserted-by":"crossref","first-page":"2858","DOI":"10.1093\/eurheartj\/ehl353","article-title":"ACUTE II Steering and Publications Committe for the ACUTE II Investigators. The Use of Enoxaparin Compared With Unfractionated Heparin for Short Term Antithrombotic Therapy in Atrial Fibrillation Patients Undergoing Echography\u2010guided Cardioversion: Assessment of Cardioversion Using Transoesophageal Echocardiography (ACUTE) II Randomized Multicentre Study","volume":"27","author":"Klein A. L.","year":"2006","journal-title":"European Heart Journal"},{"key":"e_1_2_12_22_1","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s11239-019-01876-z","article-title":"Efficacy and Safety of Rivaroxaban on Thrombus Resolution of Left Atrial\/Left Atrial Appendage Thrombus in Nonvalvular Atrial Fibrillation Patients","volume":"48","author":"Ke H.","year":"2019","journal-title":"Journal of Thrombosis and Thrombolysis"},{"issue":"11","key":"e_1_2_12_23_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S0735-1097(18)30838-6","article-title":"Impact of Anticoagulation on Resolution of Left Atrial Appendage Thrombi","volume":"71","author":"Whiteside H.","year":"2018","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_12_24_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ijcard.2015.04.104","article-title":"Uninterrupted Dabigatran versus Warfarin in the Treatment of Intracardiac Thrombus in Patients With Non\u2010Valvular Atrial Fibrillation","volume":"190","author":"Hao L.","year":"2015","journal-title":"International Journal of Cardiology"},{"key":"e_1_2_12_25_1","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1111\/pace.13765","article-title":"Non Vitamin K Oral Anticoagulants versus Warfarin for Left Atrial Appendage Thrombus Resolution in Nonvalvular Atrial Fibrillation or Flutter","volume":"42","author":"Hussain A.","year":"2019","journal-title":"Pacing and Clinical Electrophysiology"},{"key":"e_1_2_12_26_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijcha.2025.101745","article-title":"Comparison Between DOACs and Warfarin for Left Atrial Thrombus in Atrial Fibrillation Patients","volume":"59","author":"Sunaga A.","year":"2025","journal-title":"IJC Heart & Vasculature"},{"key":"e_1_2_12_27_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.curtheres.2022.100670","article-title":"Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta\u2010Analysis","volume":"96","author":"Dong S. 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M.","year":"2019","journal-title":"Anatolian Journal of Cardiology"},{"key":"e_1_2_12_35_1","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.joa.2016.01.009","article-title":"Resolution of a Warfarin and Dabigatran\u2010Resistant Left Atrial Appendage Thrombus With Apixaban","volume":"32","author":"Miwa Y.","year":"2016","journal-title":"Journal of Arrhythmia"},{"key":"e_1_2_12_36_1","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1111\/jce.14365","article-title":"Outcome of Non\u2010Vitamin K Oral Anticoagulants in the Treatment of Left Atrial\/Left Atrial Appendage Thrombus in Patients With Nonvalvular Atrial Fibrillation","volume":"31","author":"Lin C.","year":"2020","journal-title":"Journal of Cardiovascular Electrophysiology"},{"issue":"26","key":"e_1_2_12_37_1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000011117","article-title":"Anticoagulation Efficacy of dabigatran Etexilate for Left Atrial Appendage Thrombus in Patients With Atrial Fibrillation by Transthoracic and Transesophageal Echocardiography","volume":"97","author":"Xing X. F.","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"e_1_2_12_38_1","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.ahj.2014.12.020","article-title":"Rationale and Design of a Study Exploring the Efficacy of Once\u2010Daily Oral Rivaroxaban (X\u2010TRA) on the Outcome of Left Atrial\/Left Atrial Appendage Thrombus in Nonvalvular Atrial Fibrillation or Atrial Flutter and a Retrospective Observational Registry Providing Baseline Data (CLOT\u2010AF)","volume":"169","author":"Lip G. Y.","year":"2015","journal-title":"American Heart Journal"},{"key":"e_1_2_12_39_1","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.2169\/internalmedicine.56.8508","article-title":"Dabigatran Therapy Resulting in the Resolution of Rivaroxaban\u2010Resistant Left Atrial Appendage Thrombi in Patients With Atrial Fibrillation","volume":"56","author":"Watanabe T.","year":"2017","journal-title":"Internal Medicine"},{"key":"e_1_2_12_40_1","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s11239-012-0747-1","article-title":"Dabigatran and Left Atrial Appendage Thrombus","volume":"34","author":"Vidal A.","year":"2012","journal-title":"Journal of Thrombosis and Thrombolysis"},{"key":"e_1_2_12_41_1","doi-asserted-by":"crossref","unstructured":"S.Gaznabi A.Abugroun H.Mahbub andE.Campos \u201cSuccessful Resolution of a Large Left Atrial and Left Atrial Appendage Thrombus With Rivaroxaban \u201d (2019) 6076923.","DOI":"10.1155\/2019\/6076923"},{"key":"e_1_2_12_42_1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000005577","article-title":"Resolution of Massive Left Atrial Appendage Thrombi With Rivaroxaban Before Balloon Mitral Commissurotomy in Severe Mitral Stenosis: A Case Report and Literature Review","volume":"95","author":"Li Y.","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"e_1_2_12_43_1","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1159\/000354315","article-title":"Dissolution of the Left Atrial Appendage Thrombus With Rivaroxaban Therapy","volume":"36","author":"Takasugi J.","year":"2013","journal-title":"Cerebrovascular Diseases"},{"key":"e_1_2_12_44_1","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1160\/TH12-11-0821","article-title":"Resolution of Giant Left Atrial Appendage Thrombus With Rivaroxaban","volume":"109","author":"Hammerstingl C.","year":"2013","journal-title":"Thrombosis and Haemostasis"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70404","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70404","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70404","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T03:53:22Z","timestamp":1787198002000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70404"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":43,"alternative-id":["10.1111\/pace.70404"],"URL":"https:\/\/doi.org\/10.1111\/pace.70404","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"assertion":[{"value":"2025-11-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70404"}}