Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion.
Watchman
antiplatelet therapy
aspirin
left atrial appendage
oral anticoagulation
stroke
thromboembolism
Journal
JACC. Cardiovascular interventions
ISSN: 1876-7605
Titre abrégé: JACC Cardiovasc Interv
Pays: United States
ID NLM: 101467004
Informations de publication
Date de publication:
08 11 2021
08 11 2021
Historique:
received:
03
02
2021
revised:
28
05
2021
accepted:
06
07
2021
pubmed:
18
10
2021
medline:
31
3
2022
entrez:
17
10
2021
Statut:
ppublish
Résumé
This study evaluated the long-term efficacy of a standard antithrombotic strategy versus half-dose direct oral anticoagulation (DOAC) after Watchman implantation. 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. 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. Overall, 555 patients (mean age 75 ± 8 years, 63% male; median CHA 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.
Sections du résumé
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
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.
Identifiants
pubmed: 34656496
pii: S1936-8798(21)01403-5
doi: 10.1016/j.jcin.2021.07.031
pii:
doi:
Substances chimiques
Anticoagulants
0
Fibrinolytic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2353-2364Commentaires et corrections
Type : CommentIn
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Informations de copyright
Copyright © 2021. Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures Dr Di Biase has served as a consultant for Biosense Webster, Boston Scientific, Stereotaxis, and St. Jude Medical; and has received speaker honoraria from Medtronic, Atricure, EPiEP, and Biotronik. Dr Burkhardt has served as a consultant for Biosense Webster and Stereotaxis. Dr Gibson has served as a consultant for Biosense Webster, Boston Scientific and Abbott. Dr Natale has received speaker honoraria from Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik, and Medtronic; and has served as a consultant for Biosense Webster, St. Jude Medical, and Janssen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.