RISK OF ARTERIAL EMBOLIZATION IN 224 PATIENTS AWAITING CARDIAC TRANSPLANTATION

Of patients awaiting cardiac transplantation, 10% to 20% die before a donor heart becomes available. Embolization of left ventricular thromb us is a source of morbidity and mortality in this population. To defin e the incidence and possible risk factors for systemic arterial emboli zation, we examined the frequency of arterial embolic events and their relation to clinical, hemodynamic, and echocardiographic variables in 224 consecutive outpatients awaiting cardiac transplantation (left ve ntricular ejection fraction 0.20 +/- 0.07 and left ventricular end-dia stolic dimension 76 +/- 11 mm), Over a follow-up period of 301 +/- 371 days, during which 82 (37%) patients received warfarin, arterial embo lization occurred in 6 (3%) patients, 1 of whom was receiving and 5 of whom were not receiving warfarin (difference not statistically signif icant). The risk of embolization was not statistically different in pa tients with atrial fibrillation, previous embolization, or left ventri cular thrombus on transthoracic echocardiogram, regardless of warfarin therapy. Cumulative risk of sudden death was similar for patients wit h or without echocardiographically documented left ventricular thrombu s. Nonfatal bleeding complications associated with warfarin therapy oc curred in 2 (2%) patients. Thus in patients who are awaiting cardiac t ransplantation and who receive anticoagulation therapy for left ventri cular thrombus, atrial fibrillation, or previous arterial embolization , the incidence of clinically detectable arterial embolization is low despite severe ventricular dilatation. Embolization is not likely a ma jor cause of sudden death or morbidity in this population.