Anticoagulation versus antiplatelet therapy after percutaneous left atrial appendage closure—subanalysis from the multicenter LAARGE registry

Ledwoch, Jakob; Staubach, Stephan; Akın, İbrahim; İnce, Hüseyin; Zeymer, Uwe; Pleger, Sven T.; Sievert, Horst; Hochadel, Matthias; Senges, Jochen; Lewalter, Thorsten; Brachmann, Johannes; Mudra, Harald

doi:10.1007/s10840-021-01080-1

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…This is the first study that demonstrated the short-term feasibility of LAAC in Japanese hemodialysis patients. According to the recommended standard regimen for post-LAAC 45 days consisting of the combination of DOAC and low-dose aspirin [ 22 ], we administered DOAC (for non-hemodialysis patients) or warfarin (for hemodialysis patients) and low-dose aspirin and/or thienopyridine P2Y12 receptor antagonist. We adjusted the dose of warfarin with a target range of international normalized ratio between 1.5 and 2.0, according to the recommendation of guidelines.…”

Section: Discussionmentioning

confidence: 99%

Initial report of percutaneous left atrial appendage closure in hemodialysis patients with atrial fibrillation and high risk of bleeding in Japan

Ueno

Imamura

Tanaka

et al. 2022

Cardiovasc Interv and Ther

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In the countries like Japan where anticoagulation is not recommended in hemodialysis patients, the feasibility of percutaneous left atrial appendage closure (LAAC) in hemodialysis patients with non-valvular atrial fibrillation (NVAF) accompanying high risks of thromboembolic stroke and bleeding remains unknown. Peri-procedural and 45-day clinical outcomes following LAAC using WATCHMAN system, which were performed in our institute between Jun 2020 and April 2022 according to the Japanese Circulation Society guidelines, were retrospectively compared between those with and without hemodialysis. 118 patients (median 79 years, 81 men) consisting of 25 hemodialysis patients and 93 non-hemodialysis patients were included. CHADS score was 3 (2, 4) in the hemodialysis patients and 3 (2, 4) in the non-hemodialysis patients (p = 0.98). HAS-BREAD score was 4 (3, 5) in the hemodialysis patients and 3 (2, 3) in the non-hemodialysis patients (p < 0.001). All procedures were successful, except for a non-hemodialysis patient with a larger left atrial appendage. There were no major complications during index hospitalization and 45-day observational period, except for a hemodialysis patient with suspected bleeding and a non-hemodialysis patient who died due to cardiac amyloidosis. LAAC seems to be feasible in hemodialysis patients with high risks of thromboembolic events and bleedings.

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Section: Discussionmentioning

confidence: 99%

Initial report of percutaneous left atrial appendage closure in hemodialysis patients with atrial fibrillation and high risk of bleeding in Japan

Ueno

Imamura

Tanaka

et al. 2022

Cardiovasc Interv and Ther

View full text Add to dashboard Cite

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“…However, this did not affect TE rates at follow-up. Furthermore, another substudy of LAARGE recently showed no difference in TE rates between patients with AC and APAs [ 30 ]. As a result, we found no evidence that more intensive antithrombotic medication with additional AC is required in patients with preexisting SEC.…”

Section: Discussionmentioning

confidence: 99%

Is spontaneous echo contrast associated with device-related thrombus or embolic events after left atrial appendage occlusion? - Insights from the multicenter German LAARGE registry

Fastner

Müller

Brachmann

et al. 2023

J Interv Card Electrophysiol

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Background Interventional left atrial appendage occlusion (LAAO) provides an alternative to oral anticoagulation (OAC) for prophylaxis of thromboembolic events (TEs) in nonvalvular atrial fibrillation patients, predominantly in those with high bleeding risk and contraindications for long-term OAC. Although spontaneous echo contrast (SEC) is a well-known risk factor for atrial thrombus formation, little is known about whether this means an increased risk of device-related thrombus (DRT) or TEs following LAAO. Methods This substudy of the prospective, multicenter German LAARGE registry assessed two groups according to absence (SEC −) or presence of SEC (SEC +) in preprocedural cardiac imaging. Clinical and echocardiographic parameters were registered up to 1 year after LAAO. Results Five hundred eighty-eight patients (SEC − 85.5 vs. SEC + 14.5%) were included. More SEC + patients were implanted for OAC non-compliance (11.8 vs. 4.6%, p = 0.008) and a higher proportion received only antiplatelet therapy without OAC at hospital discharge (96.5 vs. 86.0%, p = 0.007). The SEC + patients had larger LA diameters (50 (47; 54) vs. 47 (43; 51) mm, p < 0.001), wider LAA ostia (21 (19; 23) vs. 20 (17; 22) mm at 45°, p = 0.011), and lower left ventricular ejection fraction (50 (45; 60) vs. 60 (50; 60) %, p < 0.001) on admission. Procedural success was very high in both groups (98.1%, p = 1.00). Periprocedural major adverse cardiac and cerebrovascular events and other major complications were rare in both groups (3.8 vs. 4.7%, p = 0.76). At follow-up, DRT was only detected in the SEC − group (3.8 vs. 0%, p = 1.00). The rates of TEs (SEC − 1.2 vs. SEC + 0%, p = 1.00) after hospital discharge and 1-year mortality (SEC − 12.0 vs. SEC + 11.8%, p = 0.96) were not significantly different between the two groups. Conclusions Presence of SEC at baseline was not associated with an increased rate of DRT or TEs at 1-year follow-up after LAAO in LAARGE.

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Anticoagulation versus antiplatelet therapy after percutaneous left atrial appendage closure—subanalysis from the multicenter LAARGE registry

Cited by 2 publications

References 16 publications

Initial report of percutaneous left atrial appendage closure in hemodialysis patients with atrial fibrillation and high risk of bleeding in Japan

Initial report of percutaneous left atrial appendage closure in hemodialysis patients with atrial fibrillation and high risk of bleeding in Japan

Is spontaneous echo contrast associated with device-related thrombus or embolic events after left atrial appendage occlusion? - Insights from the multicenter German LAARGE registry

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