Dabigatran Treatment Increased Closure Device-Related Thrombosis by Platelet Activation in Patients Undergoing Percutaneous Left Atrial Appendage Closure

Abstract

Background This study was designed to evaluate the platelet reactivity of different antithrombotic regimens under the condition of occluder implantation. Methods A single, prospective cohort study was conducted among patients who received anticoagulation with either dabigatran (N = 33) or rivaroxaban (N = 72) between January 2018 and December 2019. We applied thromboelastogram (TEG) to evaluate platelet aggregation induced with thrombin receptor activating peptide (TRAP) after anticoagulation for 3 months. Plasma coagulation markers mediate platelet activation including TAT, P-selectin, vWF and CD40L were tested by the method of ELISA kit on the day of LAAC and at 3 months after operation procedure. Repeated transesophageal echocardiographic were scheduled to evaluate device related thrombosis (DRT) formation on occluders at 3-month after discharge. Results There was 3(4.2%) in rivaroxaban and 4(12.1%) in dabigatran group experiencing DRT events (OR = 0.315, 95%CI:0.066–1.489, P = 0.129) during follow-ups. The TRAP induced platelet aggregation was higher for patients medication with dabigatran as compared to rivaroxaban group (62.9% vs. 59.7%, P = 0.028*). The plasma levels of TAT, P-selectin, vWF expression was significant higher after 3 months intake of dabigatran compared with that on the day LAAC operation, meanwhile, no significant difference was found in the changes of CD40L plasma levels. After receiving 3 months anticoagulation with rivaroxaban, the expressions of plasma platelet activation of TAT, P-selectin, vWF and CD40L showed no significant changes. We observed significant higher expressions of plasma platelet activation markers for DTR patients in terms of the P-selectin and vWF compared with non-DRT patients. Multivariate regression shwed that anticoagualtion regimen (P = 0.022; OR = 4.366, 95%CI: 0.434–10.839) was an independent predictor for DRT in patients after LAAC operation, while non of the plasma platelet activation included was associated with DRT. Conclusions By avoiding peri-procedure DRT occurrence, it is possible that dabigatran usage might even be reduced, as they had been shown to increase expressions of platelet reactivity.