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Published on: February 8, 2022
Safety and Efficacy of Single vs Dual Antiplatelets Therapy After Atrial Septal Defect Device Closure
Chandra Mani Adhikari1, Dipanker Prajapati1, Amrit Bogati1
1Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal.
Insights
Single antiplatelet therapy with Aspirin is as safe and effective as dual therapy with Aspirin and Clopidogrel following atrial septal defect device closure. This finding simplifies post-procedure treatment for patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Atrial septal defect (ASD) device closure is a standard procedure.
- Antiplatelet therapy is crucial for preventing device-related thrombus.
- Current guidelines lack definitive recommendations on optimal antiplatelet regimens.
Purpose of the Study:
- To compare the safety and efficacy of Aspirin monotherapy versus dual antiplatelet therapy (Aspirin + Clopidogrel) after ASD device closure.
Main Methods:
- A cross-sectional study included 130 adult patients undergoing ASD device closure.
- Patients received either Aspirin (ASA) or ASA + Clopidogrel for six months post-procedure.
- Outcomes monitored included ischemic events, device thrombus, bleeding, and headaches.
Main Results:
- No significant differences were observed between the Aspirin group and the Aspirin + Clopidogrel group regarding transient ischemic attack, stroke, myocardial infarction, or device thrombus.
- Rates of minor bleeding (ecchymosis) and increased headache episodes were similar in both treatment arms.
Conclusions:
- Single antiplatelet therapy with Aspirin is non-inferior to dual therapy with Aspirin and Clopidogrel in terms of safety and efficacy after ASD device closure.
- Aspirin monotherapy represents a safe and effective option, potentially simplifying treatment protocols.
Background:
Atrial septal defect device closure has become a standard procedure. Antiplatelet therapy is used to prevent thrombus formation in the device. There is no clear recommendation about the antiplatelets drugs. This study aims to evaluate the safety and efficacy of Aspirin vs (Aspirin +Clopidogrel) after device closure.
Methods:
A cross-sectional study was conducted among all consecutive adult patients (?18 years) who underwent atrial septal defect device closure from May 2019 to April 2020 and meet the inclusion criteria were included. After successful ASD device closure patients were treated with ASA or combination of ASA and Clopidogrel for six months on physician discretion. Patients were followed up for six months to observe for Transient ischemic attack, Stroke, thrombus in the device, myocardial infarction, major bleeding, minor bleeding and increases in headache episodes compared to baseline.
Results:
This study consisted of 130 patients: 65 in the Aspirin Group, and 65 patients in Aspirin and Clopidogrel group. There was no Transient ischemic attack, Stroke, Myocardial infarction, thrombus, major bleeding in both groups. There was no significant difference between two groups in ecchymosis; Aspirin group 4(6.1%) vs. aspirin and Clopidogrel group 3(4.6%) [Difference, 1.54% {95, % CI, -1.45%to 4.53%}]; P=0.648. There was no significant difference in increase in headache episodes compared to baseline for six months after the device closure in Aspirin Group 3(4.6%) VS Aspirin and Clopidogrel group 2 (3.0%) group [difference, 1.54% {95% CI, -1.45%to 4.53%}]; P=0.648.
Conclusions:
Our study suggests that single antiplatelet therapy with Aspirin is as safe and effective as aspirin and clopidogrel after device closure.
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