Key result
Modified post-LAAC regimens without DAPT linked to 0% device-related thrombosis without increasing major bleeding.
Why the study?
Antithrombotic therapy after left atrial appendage closure in patients at high risk of bleeding remains controversial.
Does a modified reduced-dose antithrombotic regimen after LAAC prevent device-related thrombosis and major bleeding compared to standard regimens in patients with high bleeding risk?
Observational (n=74)
No
Does a modified reduced-dose antithrombotic regimen after LAAC prevent device-related thrombosis and major bleeding compared to standard regimens in patients with high bleeding risk?
Answers are grounded in this paper and cite their sources.
Modified regimens without DAPT may lower device thrombosis in high-bleeding-risk patients; leaves open confirmation by randomized trials before practice change.
BACKGROUND: Antithrombotic therapy after left atrial appendage closure (LAAC) in patients at high risk of bleeding remains controversial. We present real-world clinical outcomes of LAAC. METHODS AND RESULTS: Data from 74 consecutive patients who received LAAC therapy between January 2020 and June 2022 were analyzed. Patients received 1 of 3 antithrombotic therapies according to the bleeding risk category or clinical event. Regimen 1 was based on a prior study, regimen 2 comprised a lower antiplatelet drug dose without dual antiplatelet therapy, and regimen 3 was antiplatelet drug administration for as long as possible to patients with uncontrollable bleeding who were required to stop anticoagulant drugs. Overall, 73 (98.6%) procedures were successful. Of them, 16 (21.9%) patients were selected for regimen 1, 46 (63.0%) for regimen 2, and 11 (15.1%) for regimen 3. Device-related thrombosis (13% vs. 0% vs. 0%, P=0.0257) only occurred with regimen 1. There was no difference in major bleeding event rates (6% vs. 2% vs. 9%, P=0.53). CONCLUSIONS: The post-LAAC antithrombotic regimen was modified without major concerns.
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Ryuzaki et al. (2023) conducted an observational in Nonvalvular atrial fibrillation with high bleeding risk (n=74). Modified antithrombotic regimens (Regimen 2 and 3) vs. Standard IFU-listed regimen (Regimen 1) was evaluated on Device-related thrombosis (p=0.0257). Modified post-LAAC antithrombotic regimens without dual antiplatelet therapy resulted in 0% device-related thrombosis compared to 13% with the standard regimen, with no difference in major bleeding.
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