Thrombus Detection by Echocardiography in Patients with Acute Ischemic Stroke and Chronic or New-Onset Atrial Fibrillation

Introduction

Recent articles have promoted anticoagulation for potential sources of embolism detected on echocardiography, despite lack of data regarding risk/benefit ratio for anticoagulating many of these abnormalities. Conversely, we have found echocardiography use in ambulatory stroke care to be of low yield. However, direct visualization of a thrombus might be considered a reasonable indication for anticoagulation. The current study assesses the use of transthoracic echocardiography (TTE) in thrombus detection in atrial fibrillation (AF) associated with acute stroke, which should present a good substrate for thrombus detection.

Methods

We conducted a chart review of patients admitted to our stroke department during a 6-month period, identifying and analyzing those with associated AF who were also submitted to TTE.

Results

In all, 31 patients with AF (12 chronic and 19 new onset) were studied. TTE was conducted within approximately 60 ± 41 hours. Thrombus was detected in only one patient with severe left ventricular dysfunction. Moderate to severe left ventricular function was detected in two additional patients with history of myocardial infarction. There were no other pertinent findings in 28 of 31 patients. All patients were anticoagulated on the basis of AF detection. Two died in hospital from stroke-related complications and 26 of 31 were discharged home or to rehabilitation.

Conclusions

TTE has a low yield of thrombus detection in patients with acute cardioembolic (AF-associated) stroke and has no impact on antithrombotic therapy in this patient population.

Key Words: Stroke, transient ischemic attack, echocardiography, atrial fibrillation, anticoagulation