Left Atrial Appendage Closure With Different Antithrombotic Therapies in Patients at High Bleeding Risk: A 10-Year...

Area of Science:

• Cardiology
• Pharmacology
• Medical Devices

Background:

• Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention in non-valvular atrial fibrillation (NVAF).
• High bleeding risk (HBR) patients present unique challenges for antithrombotic management post-LAAC.

Purpose of the Study:

• To evaluate the safety and efficacy of various antithrombotic strategies after LAAC in HBR patients with NVAF.
• To compare outcomes between single/dual antiplatelet therapy (SAPT/DAPT), warfarin, and non-vitamin K antagonist oral anticoagulants (NOACs).

Main Methods:

• Retrospective analysis of 893 HBR patients who underwent successful LAAC.
• Patients were categorized into four post-procedural antithrombotic groups: SAPT, DAPT, warfarin, and NOAC.
• Kaplan-Meier survival analysis and multivariate Cox regression were employed to assess outcomes.

Main Results:

• NOACs demonstrated significantly lower rates of mortality (8.1%), device-related thrombosis (DRT, 2.4%), major bleeding (0.48%), and MACE (5.9%) compared to other regimens.
• Rivaroxaban showed superior efficacy in reducing mortality, DRT, and MACE compared to dabigatran.
• The 15mg rivaroxaban dose indicated a trend towards reduced cardiac mortality and DRT.

Conclusions:

• NOACs offer a favorable balance of thrombotic and bleeding risks in HBR patients post-LAAC.
• NOACs are associated with lower DRT and fewer ischemic strokes without increased mortality.
• The 15mg rivaroxaban dose may offer superior clinical benefits.