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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Role of Different Antithrombotic Regimens after Percutaneous Left Atrial Appendage Occlusion: A Large Single Center
Patrizio Mazzone1, Alessandra Laricchia2, Giuseppe D'Angelo1
1Department of Arrhythmology and Cardiac Electrophysiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
Insights
Optimal antithrombotic therapy after left atrial appendage (LAA) occlusion is still unclear. This study suggests minimal antithrombotic therapy may be safe and effective for preventing embolism in high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Research
Background:
- Optimal antithrombotic therapy post-left atrial appendage (LAA) occlusion remains undefined.
- Left atrial appendage occlusion is a key procedure for stroke prevention in atrial fibrillation.
Purpose of the Study:
- To investigate the efficacy and safety of various antithrombotic regimens following LAA occlusion.
- To evaluate the role of "minimal" antithrombotic therapy in preventing embolic events.
Main Methods:
- Retrospective analysis of 260 patients undergoing LAA occlusion.
- Patients categorized into four groups based on discharge antithrombotic therapy.
- Assessment of baseline characteristics, procedural data, and clinical/transesophageal follow-up.
Main Results:
- Low overall incidence of adverse events across all therapy groups.
- Majority of bleeding events occurred within the first 3 months post-procedure.
- Ischemic events and left atrial thrombosis were rare, with no significant increase in the "minimal" therapy group.
Conclusions:
- Left atrial appendage occlusion is associated with a low incidence of adverse events irrespective of antithrombotic strategy.
- "Minimal" antithrombotic drug regimens appear feasible and effective for embolic prevention in high bleeding risk patients.
Background:
Optimal antithrombotic therapy after left atrial appendage (LAA) occlusion is still not clear. The aim of this study was to investigate the role of different antithrombotic regimens after the procedure.
Methods And Results:
We retrospectively analyzed data of 260 patients who underwent LAA occlusion and divided them into four groups according to therapy at discharge: dual antiplatelet therapy (group A, 71.5%); oral anticoagulants (group B, 19%); "minimal" antithrombotic therapy (single antiplatelet agent or without any antithrombotic therapy; group C, 4.5%) and other therapeutic regimens (such as a combination of antiplatelets and anticoagulants; group D, 4.5%). We analyzed baseline characteristics, procedural data, and clinical and transesophageal follow-up for each group. The incidence of adverse events was low in the whole population and had a similar distribution among groups. The majority of bleeding events was registered during the first 3 months after the procedure (34 out of 46, 70%). Ischemic events (2%), as well as silent left atrial thrombosis, were rare and not significantly higher in the population discharged with "minimal" antithrombotic therapy.
Conclusion:
Our experience seems to suggest that LAA occlusion was associated with a low incidence of adverse events, regardless of antithrombotic therapy. A "minimal" drug regimen may be feasible without losing efficacy on embolic prevention for patients with high bleeding risk.
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