Treatment of Device-Related Thrombosis After Left Atrial Appendage Occlusion: Initial Experience With Low-Dose Apixaban.
Journal
Cardiovascular revascularization medicine : including molecular interventions
ISSN: 1878-0938
Titre abrégé: Cardiovasc Revasc Med
Pays: United States
ID NLM: 101238551
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
21
09
2021
revised:
01
11
2021
accepted:
04
11
2021
pubmed:
11
11
2021
medline:
28
6
2022
entrez:
10
11
2021
Statut:
ppublish
Résumé
Left atrial appendage (LAA) closure devices require short-term postprocedural oral antithrombotic therapy (AT) to prevent device-related thrombosis (DRT) until device endothelialization occurs. Currently, there is no consensus regarding the optimal AT strategy for DRT prevention. The purpose of our case series is to summarize our experience using apixaban at reduced doses for effectively treating DRT. Among a total of 180 patients, 11 patients (6.1%) presented DRT and 4 were specifically treated with low-dose apixaban (2.5 mg/12 h). The mean CHA2DS2-VASc and HAS-BLED scores were high [5 (SD ±1.2) and 3.25 (SD ±0.5), respectively] and all patients had history of a major hemorrhagic event (BARC Score ≥3) mostly gastrointestinal (n = 3). An Amplazer Amulet device was implanted in 3 patients, and a LAmbre system in one patient. AT strategy at the time of DRT diagnosis was consistently single antiplatelet therapy in all patients. Following DRT diagnosis, reduced dose of apixaban was initiated in all the patients. No major or minor bleeding events occurred during apixaban administration. Apixaban low dose regimen could be a feasible option to prevent DRT while keeping a low risk of bleeding.
Sections du résumé
BACKGROUND
Left atrial appendage (LAA) closure devices require short-term postprocedural oral antithrombotic therapy (AT) to prevent device-related thrombosis (DRT) until device endothelialization occurs. Currently, there is no consensus regarding the optimal AT strategy for DRT prevention.
METHODS
The purpose of our case series is to summarize our experience using apixaban at reduced doses for effectively treating DRT.
RESULTS
Among a total of 180 patients, 11 patients (6.1%) presented DRT and 4 were specifically treated with low-dose apixaban (2.5 mg/12 h). The mean CHA2DS2-VASc and HAS-BLED scores were high [5 (SD ±1.2) and 3.25 (SD ±0.5), respectively] and all patients had history of a major hemorrhagic event (BARC Score ≥3) mostly gastrointestinal (n = 3). An Amplazer Amulet device was implanted in 3 patients, and a LAmbre system in one patient. AT strategy at the time of DRT diagnosis was consistently single antiplatelet therapy in all patients. Following DRT diagnosis, reduced dose of apixaban was initiated in all the patients. No major or minor bleeding events occurred during apixaban administration.
CONCLUSIONS
Apixaban low dose regimen could be a feasible option to prevent DRT while keeping a low risk of bleeding.
Identifiants
pubmed: 34753670
pii: S1553-8389(21)00734-X
doi: 10.1016/j.carrev.2021.11.007
pii:
doi:
Substances chimiques
Pyrazoles
0
Pyridones
0
apixaban
3Z9Y7UWC1J
Types de publication
Letter
Langues
eng
Sous-ensembles de citation
IM
Pagination
201-203Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest None.