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Published on: February 26, 2013
Left Atrial Appendage Closure With Different Antithrombotic Therapies in Patients at High Bleeding Risk: A 10-Year
Xiaoqi Niu1, Xizhi Tang1, Xiaonan Fang1
1Department of Cardiovascular Medicine, Southwest Hospital, Army Medical University, Key Laboratory of Geriatric Cardiovascular and Cerebrovascular Disease, Ministry of Education of China, and Key Laboratory of Chronobiology and Cardiometabolic Disease, Chongqing Education Commission of China, Chongqing, China.
Insights
Non-vitamin K antagonist oral anticoagulants (NOACs) show improved outcomes in high bleeding risk patients post-left atrial appendage closure (LAAC). NOACs reduce mortality, device-related thrombosis, and major adverse cardiovascular events without increasing bleeding risk.
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.
Background:
In this study we aimed to evaluate the safety and efficacy of different antithrombotic strategy after left atrial appendage closure (LAAC) in high bleeding risk patients with nonvalvular atrial fibrillation.
Methods:
In this study we included 893 patients with high bleeding risk who successfully underwent LAAC and categorized them into 4 groups on the basis of postprocedural antithrombotic regimen: single antiplatelet therapy (n = 27) or dual antiplatelet therapy (n = 143), warfarin (n = 97), and non-vitamin K antagonist oral anticoagulants (NOACs; n = 626). Kaplan-Meier survival curves and multivariate Cox regression were used.
Results:
During a mean follow-up period of 46.17 months, the NOAC group exhibited superior outcomes: lower incidence of mortality (8.1% vs 10.5% for dual antiplatelet therapy, 18.6% for warfarin, and 14.8% for single antiplatelet therapy; P = 0.011), device-related thrombosis (DRT, 2.4% vs 7.0%, and 4.1%; P = 0.045), major bleeding (0.48% vs 2.1%, 2.0%, and 3.7%; P = 0.027) and major adverse cardiovascular events (5.9% vs 13.3%, 11.3%, and 7.4%; P = 0.012). Rivaroxaban showed greater efficacy in reducing mortality (6.9% vs 13.1%), DRT (1.6% vs 5.7%), and major adverse cardiovascular events (5.0% vs 9.8%), compared with dabigatran (all P < 0.05). The 15-mg dose showed a potential trend in reducing cardiac mortality and DRT (all P > 0.05).
Conclusions:
For high bleeding risk patients after LAAC, NOACs might provide a more favourable balance between thrombotic and bleeding risks, with less DRT and fewer ischemic strokes, without increasing mortality. Compared with the other doses, the 15-mg rivaroxaban group showed a potentially superior trend.
Clinical Trial Registration:
Chinese Clinical Trial Registry: PID: 263473.
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