Antiplatelet Therapy Following LA Appendage Closure
What is the feasibility, safety, and efficacy of single antiplatelet therapy after left atrial appendage closure (LAAC) in patients with a contraindication to anticoagulation therapy and high risk of bleeding?
This pilot study included 31 patients with nonvalvular atrial fibrillation, contraindication to long-term anticoagulation, and high risk of bleeding determined by a HAS-BLED score ≥3. All patients had an annual stroke risk >2%, as determined by a CHADS2 score ≥1 or CHA2DS2-VASc score ≥2. The antithrombotic treatment following LAAC consisted of single antiplatelet therapy with either aspirin (80-100 mg/24 hours) or clopidogrel (75 mg/24 hours) indefinitely. Clinical follow-up was obtained at 45 days, 6 months, 12 months, and yearly thereafter.
Median follow-up was 19 (12-24) months and no patient was lost to follow-up. Five patients (16.1%) died during the follow-up period, none of them related to the device or to cardioembolic/bleeding causes. There was no stroke or systemic embolism during the follow-up period (expected annual rates of stroke or thromboembolism according to CHA2DS2-VASc score of 8.1% and 11.2%, respectively). One patient (3.2%) had major gastrointestinal bleeding (expected annual rate of bleeding according to HAS-BLED score of 8.6%).
The authors concluded that the present study showed the preliminary safety and efficacy of single antiplatelet therapy following LAAC.
This study reports that single antiplatelet therapy after LAAC in patients with a high risk of bleeding is associated with a low rate of cardioembolic and bleeding complications at a median follow-up of 19 months. The bleeding rate in the present study was lower than expected based on the HAS-BLED score, suggesting that single antiplatelet therapy may be the optimal therapy for patients at high risk of bleeding undergoing LAAC. Additional larger randomized trials are indicated to confirm the safety and efficacy of single antiplatelet therapy following LAAC.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Anticoagulants, Arrhythmias, Cardiac, Aspirin, Atrial Appendage, Atrial Fibrillation, Embolism, Hemorrhage, Platelet Aggregation Inhibitors, Stroke, Thromboembolism
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