Efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion
Aim. To evaluate the efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion (LAAO) in real clinical practice.Material and methods. This prospective observational study included 90 patients with nonvalvular atrial fibrillation and a high risk of ischemic stroke/s...
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«SILICEA-POLIGRAF» LLC
2022-09-01
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| Series: | Кардиоваскулярная терапия и профилактика |
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| Online Access: | https://cardiovascular.elpub.ru/jour/article/view/3353 |
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| author | D. V. Pevsner Yu. K. Rytova I. Merkulova E. V. Merkulov |
| author_facet | D. V. Pevsner Yu. K. Rytova I. Merkulova E. V. Merkulov |
| author_sort | D. V. Pevsner |
| collection | DOAJ |
| description | Aim. To evaluate the efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion (LAAO) in real clinical practice.Material and methods. This prospective observational study included 90 patients with nonvalvular atrial fibrillation and a high risk of ischemic stroke/systemic embolism who underwent endovascular LAAO using the Watchman device. The primary endpoint was the cumulative incidence of ischemic stroke/transient ischemic attack/systemic embolism, major and clinically relevant bleeding according to the Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD) criteria, and all-cause mortality.Results. Patients were divided into subgroups depending on the antithrombotic therapy carried out after LAAO: 1) direct oral anticoagulants (DOACs) ± antiplatelet agents; 2) warfarin ± antiplatelet agents; 3) dual antiplatelet therapy (aspirin + clopidogrel). Multivariate analysis showed a trend toward a lower incidence of the primary endpoint in the DOAC group compared with both warfarin (hazard ratio, 8,49; 95% confidence interval: 2,0-36,15; p=0,004) and antiplatelet agents (hazard ratio, 4,34; 95% confidence interval: 1,08-17,36; p=0,038). At the same time, there were no significant differences in the prevalence of primary endpoint between the warfarin and antiplatelet groups. There was no relationship between device-related thrombosis and postoperative antithrombotic regimen.Conclusion. Endovascular LAAO is an effective and safe alternative to anticoagulant therapy. The present real-world evidence study revealed that the administration of DOACs after LAAO is associated with a greater efficacy and safety profile compared to warfarin and dual antiplatelet therapy. |
| format | Article |
| id | doaj-art-6d9edfd5126342daa20ba0c18e42c84f |
| institution | DOAJ |
| issn | 1728-8800 2619-0125 |
| language | Russian |
| publishDate | 2022-09-01 |
| publisher | «SILICEA-POLIGRAF» LLC |
| record_format | Article |
| series | Кардиоваскулярная терапия и профилактика |
| spelling | doaj-art-6d9edfd5126342daa20ba0c18e42c84f2025-08-20T02:59:11Zrus«SILICEA-POLIGRAF» LLCКардиоваскулярная терапия и профилактика1728-88002619-01252022-09-0121810.15829/1728-8800-2022-33532519Efficacy and safety of various antithrombotic regimens after left atrial appendage occlusionD. V. Pevsner0Yu. K. Rytova1I. Merkulova2E. V. Merkulov3E.I. Chazov National Medical Research Center of CardiologyE.I. Chazov National Medical Research Center of CardiologyE.I. Chazov National Medical Research Center of CardiologyE.I. Chazov National Medical Research Center of CardiologyAim. To evaluate the efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion (LAAO) in real clinical practice.Material and methods. This prospective observational study included 90 patients with nonvalvular atrial fibrillation and a high risk of ischemic stroke/systemic embolism who underwent endovascular LAAO using the Watchman device. The primary endpoint was the cumulative incidence of ischemic stroke/transient ischemic attack/systemic embolism, major and clinically relevant bleeding according to the Global Anticoagulant Registry in the Field-Atrial Fibrillation (GARFIELD) criteria, and all-cause mortality.Results. Patients were divided into subgroups depending on the antithrombotic therapy carried out after LAAO: 1) direct oral anticoagulants (DOACs) ± antiplatelet agents; 2) warfarin ± antiplatelet agents; 3) dual antiplatelet therapy (aspirin + clopidogrel). Multivariate analysis showed a trend toward a lower incidence of the primary endpoint in the DOAC group compared with both warfarin (hazard ratio, 8,49; 95% confidence interval: 2,0-36,15; p=0,004) and antiplatelet agents (hazard ratio, 4,34; 95% confidence interval: 1,08-17,36; p=0,038). At the same time, there were no significant differences in the prevalence of primary endpoint between the warfarin and antiplatelet groups. There was no relationship between device-related thrombosis and postoperative antithrombotic regimen.Conclusion. Endovascular LAAO is an effective and safe alternative to anticoagulant therapy. The present real-world evidence study revealed that the administration of DOACs after LAAO is associated with a greater efficacy and safety profile compared to warfarin and dual antiplatelet therapy.https://cardiovascular.elpub.ru/jour/article/view/3353atrial fibrillationleft atrial appendage occluderprevention of ischemic strokeantithrombotic therapyantiplatelet therapyanticoagulant therapy |
| spellingShingle | D. V. Pevsner Yu. K. Rytova I. Merkulova E. V. Merkulov Efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion Кардиоваскулярная терапия и профилактика atrial fibrillation left atrial appendage occluder prevention of ischemic stroke antithrombotic therapy antiplatelet therapy anticoagulant therapy |
| title | Efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion |
| title_full | Efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion |
| title_fullStr | Efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion |
| title_full_unstemmed | Efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion |
| title_short | Efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion |
| title_sort | efficacy and safety of various antithrombotic regimens after left atrial appendage occlusion |
| topic | atrial fibrillation left atrial appendage occluder prevention of ischemic stroke antithrombotic therapy antiplatelet therapy anticoagulant therapy |
| url | https://cardiovascular.elpub.ru/jour/article/view/3353 |
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