Abstract
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.
Highlights
Atrial fibrillation (AF) is a common, age-related arrhythmia, with 1.5–2% prevalence in the general population
Some type of intensive antithrombotic therapy is prescribed for a period of at least 1–3 months and until device endothelialization, followed by a de-escalation strategy, which consists of single antiplatelet therapy in the majority of cases
The aim of this study is to investigate the role of antithrombotic therapy after left atrial appendage (LAA) occlusion in a high-volume center, with particular interest in the incidence of ischemic and hemorrhagic complications during the first three months after discharge
Summary
Atrial fibrillation (AF) is a common, age-related arrhythmia, with 1.5–2% prevalence in the general population. Some type of intensive antithrombotic therapy is prescribed for a period of at least 1–3 months and until device endothelialization, followed by a de-escalation strategy, which consists of single antiplatelet therapy in the majority of cases. This strategy is based on the results of previous large randomized clinical trials that enrolled patients without any contraindication to oral anticoagulation, or on the experience with other percutaneously implanted devices as interatrial septum occluders. A “minimal” drug regimen may be feasible without losing efficacy on embolic prevention for patients with high bleeding risk
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