Dual antiplatelet therapy after percutaneous left atrial appendage occlusion: single center experience with the Amplatzer Cardiac Plug

Bertrand, P.; Habran, Melanie; Kenis, Karlijn; Lecomte, J; Moonen, L.; Stroobants, Didier; Benit, Edouard

doi:10.1080/00015385.2018.1455946

Cited by 7 publications

(2 citation statements)

References 21 publications

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“…This may also explain the high bleeding rates in the postimplant period of the PRAGUE‐17 trial 7 . Other non‐randomized series implanting LAAO in patients with high‐risk of bleeding with long term anticoagulation have also used dual antiplatelets or single antiplatelets in the postoperative period 10–15 . The multicenter Amulet Registry is one of the largest series and had a similar rate of bleeding to PRAGUE‐17 16 .…”

Section: Discussionmentioning

confidence: 99%

“…7 Other non-randomized series implanting LAAO in patients with high-risk of bleeding with long term anticoagulation have also used dual antiplatelets or single antiplatelets in the postoperative period. [10][11][12][13][14][15] The multicenter Amulet Registry is one of the largest series and had a similar rate of bleeding to PRAGUE-17. 16 A single center series with a higher proportion of patients with prior bleeds, used a shorter period of dual antiplatelets had a lower bleeding rate but a higher ischemic stroke rate.…”

Section: Randomized Controlled Trials Have Shown That Laao Withmentioning

confidence: 99%

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Left atrial appendage occlusion for atrial fibrillation and bleeding diathesis

Kailey,

Koa‐Wing,

Sutaria

et al. 2023

Cardiovasc electrophysiol

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BackgroundPatients with atrial fibrillation (AF) and likelihood of bleeding can undergo left atrial appendage occlusion (LAAO) as an alternative method of stroke prophylaxis. Short‐term anti‐thrombotic drugs are used postprocedure to offset the risk of device‐related thrombus, evidence for this practice is limited.ObjectivesTo investigate optimal postimplant antithrombotic strategy in high bleeding‐risk patients.MethodsPatients with AF and high‐risk for both stroke and bleeding undergoing LAAO were advised their perioperative drug therapy by a multidisciplinary physician panel. Those deemed to be at higher risk of bleeding from anti‐thrombotic drugs were assigned to minimal treatment with no antithrombotics or Aspirin‐alone. The remaining patients received standard care (STG) with a 12 week course of dual‐antiplatelets or anticoagulation postimplant. We compared mortality, device‐related thrombus, ischemic stroke, and bleeding events during the 90 days postimplant and long‐term. Event‐free survival was assessed using Kaplan−Meier survival analysis, with logrank testing for statistical significance.ResultsSeventy‐five patients underwent LAAO of whom 63 patients (84%) had a prior serious bleeding event. The 42 patients on minimal treatment were older (74.3 ± 7.7 vs. 71.2 ± 7.2) with higher HASBLED score (3.6 ± 0.9 vs. 3.3 ± 1.2) than the 33 patients having standard care. There were no device‐related thrombi or strokes in either group at 90 days postprocedure; STG had more bleeding events (5/33 vs. 0/42, p = 0.01) with associated deaths (3/33 vs. 0/42, p = 0.05). During long‐term follow‐up (median 2.2 years), all patients transitioned onto no antithrombotic drugs (43 patients [61%]) or a single‐antiplatelet (29 patients [39%]). There was no evidence of early minimal treatment adversely affecting long‐term outcomes.ConclusionsShort‐term anti‐thrombotic drugs may not be needed after LAAO implant in patients with high bleeding risk and could be harmful. Larger, prospective studies would be warranted to test these findings.

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Section: Discussionmentioning

confidence: 99%