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Early Discontinuation of Antithrombotic Treatment Following Left Atrial Appendage Closure

Mesnier, Jules ; Cruz-González, Ignacio ; Arzamendi, Dabit ; Freixa, Xavier ; Nombela-Franco, Luis ; Peral, Vicente ; Caneiro-Queija, Berenice ; Mangieri, Antonio ; Trejo-Velasco, Blanca ; Asmarats, Lluis ; Regueiro, Ander ; McInerney, Angela ; Mas-Lladó, Caterina ; Estevez-Loureiro, Rodrigo ; Laricchia, Alessandra ; O'Hara, Gilles ; Rodés-Cabau, Josep

The American journal of cardiology, 2022-05, Vol.171, p.91-98 [Periódico revisado por pares]

United States: Elsevier Inc

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Título:
Early Discontinuation of Antithrombotic Treatment Following Left Atrial Appendage Closure
Autor: Mesnier, Jules ; Cruz-González, Ignacio ; Arzamendi, Dabit ; Freixa, Xavier ; Nombela-Franco, Luis ; Peral, Vicente ; Caneiro-Queija, Berenice ; Mangieri, Antonio ; Trejo-Velasco, Blanca ; Asmarats, Lluis ; Regueiro, Ander ; McInerney, Angela ; Mas-Lladó, Caterina ; Estevez-Loureiro, Rodrigo ; Laricchia, Alessandra ; O'Hara, Gilles ; Rodés-Cabau, Josep
Assuntos: Anticoagulants ; Atrial Appendage - surgery ; Atrial Fibrillation - complications ; Atrial Fibrillation - drug therapy ; Bleeding ; Clinical outcomes ; Clinical trials ; Confidence intervals ; Consortia ; Contraindications ; Death ; Fibrinolytic Agents - therapeutic use ; Hemorrhage - epidemiology ; Humans ; Ischemia ; Ischemic Stroke ; Mortality ; Patients ; Risk ; Safety ; Stroke ; Stroke - epidemiology ; Stroke - etiology ; Stroke - prevention & control ; Thromboembolism ; Treatment Outcome
É parte de: The American journal of cardiology, 2022-05, Vol.171, p.91-98
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SourceType-Scholarly Journals-1
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Descrição: Although antithrombotic treatment is recommended after left atrial appendage closure (LAAC), some patients require discontinuation of antithrombotic treatment after LAAC without evidence on the safety of such a strategy. We sought to evaluate outcomes of patients who had early antithrombotic treatment discontinuation after LAAC. This is a multicenter study including 1,082 patients who underwent successful LAAC. Early discontinuation of antithrombotic treatment was defined as discontinuation of all antiplatelet/anticoagulant treatment within 6 months following the procedure. A propensity-matched analysis was used to compare outcomes of patients with and without early antithrombotic treatment discontinuation. A total of 148 patients (13.7%) had early antithrombotic treatment discontinuation. In the entire population, antithrombotic treatment discontinuation patients exhibited a lower CHA2DS2-VASc score (p <0.001) and a higher rate of previous gastrointestinal bleeding episodes (p = 0.01) compared with patients without discontinuation. After a median follow-up of 2.1 (1,1-3.1) years after antithrombotic treatment discontinuation, the rates of death, ischemic stroke, and major bleeding were 12.1, 0.6, and 3.3 per 100 patient-years. In 119 matched pairs with similar baseline characteristics, antithrombotic treatment discontinuation patients had a similar risk of death (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.65 to 1.71, p = 0.82), ischemic stroke (HR 0.39, 95% CI 0.04 to 3.79, p = 0.42) and major bleeding (HR 1.48, 95% CI 0.56 to 3.88, p = 0.43) compared with those without discontinuation. In conclusion, antithrombotic treatment was discontinued in 1 of 7 selected patients within 6 months after LAAC, and this was not associated with an increased risk of death or thromboembolic events after a median follow-up of 2 years. These data support the safety of shorter periods of antithrombotic therapy after LAAC in high bleeding risk patients based on clinician judgment. Further trials are warranted.
Editor: United States: Elsevier Inc
Idioma: Inglês

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Early Discontinuation of Antithrombotic Treatment Following Left Atrial Appendage Closure

United States: Elsevier Inc

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