Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion
Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion
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DOI：
10.1016/j.jcin.2021.07.031
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发表时间：
2021-11-01
影响因子：
11.3
通讯作者：
Natale, Andrea
中科院分区：
文献类型：
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作者：
Della Rocca, Domenico G.;Magnocavallo, Michele;Natale, Andrea
目的 本研究评估了 Watchman 植入后标准抗血栓策略与半剂量直接口服抗凝 (DOAC) 的长期疗效。 背景 目前，对于选择最有效的抗血栓策略来预防接受心内膜左心耳封堵术的患者中装置相关血栓 (DRT)，尚无共识。 方法 成功左心耳封堵术后，连续患者接受标准抗血栓策略 (SAT) 或长期半剂量 DOAC (hdDOAC)。主要复合终点是 DRT 和血栓栓塞 (TE) 和出血事件。 结果 总体而言，555 名患者（平均年龄 75 +/- 8 岁，63% 男性；中位 CHA(2)DS(2)-VASc [充血性心力衰竭、高血压、年龄 >= 75 岁、糖尿病、既往中风或短暂性脑缺血发作或血栓栓塞、血管疾病、年龄 65-74 岁、性别类别] 评分 4 [四分位距 (IQR)：3-6]；中位 HAS-BLED [高血压、肾功能或肝功能异常、中风、出血、不稳定的国际标准化比值、老年人、药物或酒精]评分 3 [IQR：2-4]）。患者被分为 2 组（SAT：n = 357 与 hdDOAC：n = 198）。各组之间的基线临床特征相似。中位随访时间为 13 个月（IQR：12-15 个月）。 12 名 (2.1%) 患者发生了 DRT，全部属于 SAT 组（3.4% vs 0.0%；对数秩 P = 0.009）。 hdDOAC 组的非手术性大出血风险明显更高（0.5% vs. 3.9%；对数秩 P = 0.018）。 SAT 患者中 DRT 和 TE 以及大出血事件的主要复合终点发生率为 9.5%，hdDOAC 患者中为 1.0%（HR：9.8；95% CI：2.3-40.7；P = 0.002）。以抗血小板、抗血栓治疗为基础。 (C) 2021 由爱思唯尔代表美国心脏病学会基金会发布。
OBJECTIVES This study evaluated the long-term efficacy of a standard antithrombotic strategy versus half-dose direct oral anticoagulation (DOAC) after Watchman implantation.BACKGROUND No consensus currently exists on the selection of the most effective antithrombotic strategy to prevent device-related thrombosis (DRT) in patients undergoing endocardial left atrial appendage closure.METHODS After successful left atrial appendage closure, consecutive patients were prescribed a standard antithrombotic strategy (SAT) or long-term half-dose DOAC (hdDOAC). The primary composite endpoint was DRT and thromboembolic (TE) and bleeding events.RESULTS Overall, 555 patients (mean age 75 +/- 8 years, 63% male; median CHA(2)DS(2)-VASc [congestive heart failure, hypertension, age >= 75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category] score 4 [interquartile range (IQR): 3-6]; median HAS-BLED [hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol] score 3 [IQR: 2-4]) were included. Patients were categorized into 2 groups (SAT: n = 357 vs hdDOAC: n = 198). Baseline clinical characteristics were similar between groups. The median follow-up duration was 13 months (IQR: 12-15 months). DRT occurred in 12 (2.1%) patients, all in the SAT group (3.4% vs 0.0%; log-rank P = 0.009). The risk of nonprocedural major bleeding was significantly more favorable in the hdDOAC group (0.5% vs. 3.9%; log-rank P = 0.018). The rate of the primary composite endpoint of DRT and TE and major bleeding events was 9.5% in SAT patients and 1.0% in hdDOAC patients (HR: 9.8; 95% CI: 2.3-40.7; P = 0.002).CONCLUSIONS After successful Watchman implantation, long-term half-dose DOAC significantly reduced the risk of the composite endpoint of DRT and TE and major bleeding events compared with a standard, antiplatelet-based, antithrombotic therapy. (C) 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.