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Vol. 77. Issue 2.
Pages 150-157 (February 2024)
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Vol. 77. Issue 2.
Pages 150-157 (February 2024)
Original article
Single antiplatelet therapy after left atrial appendage closure in patients with AF: safety and effectiveness
Efectividad y seguridad de una estrategia de antiagregación plaquetaria simple tras cierre percutáneo de orejuela izquierda en pacientes con FA
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Marc Llagostera-Martína,
Corresponding author
mllagostera@psmar.cat

Corresponding author.
, Miguel Cainzosa,b, Neus Salvatellaa, Héctor Cubero-Gallegoa,b, Aleksandra Mas-Stachurskaa,c, Andrea Sánchez-Carpinteroa, Helena Tizón-Marcosa,b,d, Alicia Calvo-Fernándeza,e, Luis Molinaa,b,e, Beatriz Vaquerizoa,b,e,f
a Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
b Grupo de Investigación en Enfermedades del Corazón (GREC), Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
c Servicio de Cardiología, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
d Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
e Departamento de Medicina, Universidad Pompeu Fabra, Barcelona, Spain
f Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
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Tables (5)
Table 1. Baseline characteristics of the study participants (n=74)
Table 2. Imaging results at 1 month and 1 year (n=74)
Table 3. Clinical events during follow-up (n=74)
Table 4. Characteristics of major bleeding events (BARC ≥ 3a) occurring during follow-up
Table 5. Comparison of DRT incidence by device, diagnostic method, and antithrombotic therapy
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Abstract
Introduction and objectives

The optimal antithrombotic strategy following left atrial appendage closure (LAAC) is poorly defined in patients with nonvalvular atrial fibrillation. We assessed the safety and effectiveness of a single antiplatelet treatment (SAPT) strategy after LAAC in a population at high risk of ischemic and bleeding events.

Methods

This single-center, observational, prospective study included a consecutive cohort of patients who underwent LAAC using the LAmbre device (Lifetech Scientific, China) and who were discharged with SAPT. The primary outcome was a composite of stroke, systemic embolism, and device-related thrombosis during follow-up. Secondary endpoints were cardiovascular mortality and major bleeding events (BARC ≥3a). Clinical follow-up was performed at 1, 6, and 12 months and subsequently on an annual basis. Transesophageal echocardiography was performed at 1 and 12 months of follow-up.

Results

The study comprised 74 patients. The median age was 77 [72-83] years and 43% were women. The cohort exhibited a high prevalence of comorbidities and cardiovascular risk factors. The median CHA2DS2-VASc and HAS-BLED scores were 4 [3-6] and 4 [4-5], respectively. The median length of follow-up was 2.5 years (188 patients-year). During follow-up, device-related thrombosis occurred in 3 patients (4%). Ischemic stroke occurred in 1 patient (1.3%, rate 0.5%/y), representing a 90.9% relative risk reduction compared with the risk predicted by CHA2DS2-VASc. Major bleeding events occurred in 12 patients (16%, 6.4%/y), with a relative risk reduction of 26.4% of that predicted by HAS-BLED. Cardiovascular-related mortality was observed in 2 patients (2.7%).

Conclusions

SAPT appears to be a safe and effective treatment following LAAC in patients at high ischemic and hemorrhagic risk. Further studies are needed to confirm our findings.

Keywords:
Left atrial appendage closure
Atrial fibrillation
Antiplatelets
Thrombosis
Bleeding
LAmbre
Stroke
Embolism
Abbreviations:
AF
DRT
LAAC
OACs
SAPT
Resumen
Introducción y objetivos

Se desconoce cuál es la terapia antitrombótica óptima tras el cierre percutáneo de la orejuela izquierda (CPOI) en pacientes con fibrilación auricular no valvular. El objetivo de este estudio es analizar la efectividad y la seguridad de un régimen de tratamiento antiagregante plaquetario simple (TAPS) tras el CPOI en una población con alto riesgo isquémico y hemorrágico.

Métodos

Estudio observacional prospectivo que incluyó una cohorte consecutiva de pacientes a los que se realizó CPOI con dispositivo LAmbre (Lifetech Scientific, China) y que recibieron TAPS al alta. El evento primario fue un combinado de ictus, embolia sistémica y trombosis del dispositivo. Los eventos secundarios fueron mortalidad cardiovascular y hemorragia mayor (BARC ≥ 3a). Se realizó seguimiento clínico al mes y a los 6 y 12 meses y cada año después. Se realizó ecocardiograma transesofágico al mes y a los 12 meses.

Resultados

Se incluyó a 74 pacientes (el 43% mujeres) con una mediana de edad de 77 [intervalo intercuartílico, 72-83] años, que presentaban gran comorbilidad y factores de riesgo cardiovascular. Los valores de CHA2DS2-VASc y HAS-BLED fueron una mediana de 4 [3-6] y 4 [4-5] respectivamente. Durante el seguimiento (mediana, 2,5 años), 3 pacientes (4%) presentaron trombosis del dispositivo. Uno sufrió ictus isquémico (1,3%, 0,5%/año), lo que supone, según la incidencia esperada por CHA2DS2-VASc, una reducción del riesgo relativo del 90,9%. Sufrieron eventos hemorrágicos 12 pacientes (16%; 6,4%/año), una tasa el 26,4% menor que el riesgo HAS-BLED predicho. Se produjo la muerte cardiovascular de 2 pacientes (2,7%).

Conclusiones

Una estrategia de TAPS tras el CPOI parece ser una opción efectiva y segura para los pacientes con altos riesgos isquémico y hemorrágico. Se necesitan más estudios que corroboren nuestros resultados.

Palabras clave:
Cierre percutáneo de la orejuela izquierda
Fibrilación auricular
Antiplaquetario
Trombosis
Hemorragia
LAmbre
Ictus
Embolia

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