Lower Rate of Major Bleeding in Very High-Risk Patients Undergoing Left Atrial Appendage Occlusion: A Propensity-Matched Comparison with Direct Oral Anticoagulation.

Watchman atrial fibrillation bleeding left atrial appendage oral anticoagulant stroke prevention

Journal

Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317

Informations de publication

Date de publication:
19 Jan 2024
Historique:
received: 25 06 2023
revised: 10 01 2024
accepted: 12 01 2024
medline: 22 1 2024
pubmed: 22 1 2024
entrez: 21 1 2024
Statut: aheadofprint

Résumé

Long-term oral anticoagulation is the mainstay therapy for thromboembolic (TE) prevention in patients with atrial fibrillation (AF). However, left atrial appendage occlusion (LAAO) could be a safe alternative to direct oral anticoagulants (DOACs) in patients with a very high thromboembolic risk profile. to compare the safety and efficacy of LAAO versus DOACs among AF patients at very high stroke risk (CHA Data from patients with a CHA Among 2381 patients, 554 very high-risk patients were included in the study (79 ± 7 years; CHA Among high-risk patients, LAAO had similar stroke prevention efficacy but a significantly lower risk of clinically-relevant bleeding when compared with DOACs. LAAO clinical benefit became significant after 18 months of follow-up.

Sections du résumé

BACKGROUND BACKGROUND
Long-term oral anticoagulation is the mainstay therapy for thromboembolic (TE) prevention in patients with atrial fibrillation (AF). However, left atrial appendage occlusion (LAAO) could be a safe alternative to direct oral anticoagulants (DOACs) in patients with a very high thromboembolic risk profile.
OBJECTIVE OBJECTIVE
to compare the safety and efficacy of LAAO versus DOACs among AF patients at very high stroke risk (CHA
METHODS METHODS
Data from patients with a CHA
RESULTS RESULTS
Among 2381 patients, 554 very high-risk patients were included in the study (79 ± 7 years; CHA
CONCLUSIONS CONCLUSIONS
Among high-risk patients, LAAO had similar stroke prevention efficacy but a significantly lower risk of clinically-relevant bleeding when compared with DOACs. LAAO clinical benefit became significant after 18 months of follow-up.

Identifiants

DOI: 10.1016/j.hrthm.2024.01.018 PMID: 38246567
pubmed: 38246567
pii: S1547-5271(24)00070-5
doi: 10.1016/j.hrthm.2024.01.018
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Michele Magnocavallo (M)

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA;; Cardiology Division, Arrhythmology Unit, Fatebenefratelli Isola Tiberina Gemelli-Isola, 00186 Rome, Italy.

Domenico G Della Rocca (DG)

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA;; Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium;. Electronic address: domenicodellarocca@hotmail.it.

Giampaolo Vetta (G)

Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium;; Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.

Sanghamitra Mohanty (S)

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.

Carola Gianni (C)

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.

Marco Polselli (M)

Cardiology Division, Arrhythmology Unit, Fatebenefratelli Isola Tiberina Gemelli-Isola, 00186 Rome, Italy.

Pietro Rossi (P)

Cardiology Division, Arrhythmology Unit, Fatebenefratelli Isola Tiberina Gemelli-Isola, 00186 Rome, Italy.

Antonio Parlavecchio (A)

Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.

Mirco Vincenzo La Fazia (MV)

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.

Fabrizio Guarracini (F)

Department of Cardiology, S. Chiara Hospital, Trento, Italy.

Francesco De Vuono (F)

Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

Antonio Bisignani (A)

Cardiology Division, Arrhythmology Unit, Fatebenefratelli Isola Tiberina Gemelli-Isola, 00186 Rome, Italy.

Luigi Pannone (L)

Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium.

Sergio Raposeiras-Roubín (S)

Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain.

Stijn Lochy (S)

Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium.

Filippo Maria Cauti (FM)

Arrhythmology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.

J David Burkhardt (JD)

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.

Serge Boveda (S)

Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium;; Heart Rhythm Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse Cedex 3, France.

Andrea Sarkozy (A)

Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium.

Antonio Sorgente (A)

Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium.

Stefano Bianchi (S)

Cardiology Division, Arrhythmology Unit, Fatebenefratelli Isola Tiberina Gemelli-Isola, 00186 Rome, Italy.

Gian-Battista Chierchia (GB)

Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium.

Carlo de Asmundis (C)

Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium.

Amin Al-Ahmad (A)

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.

Luigi Di Biase (L)

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA;; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

Rodney P Horton (RP)

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.

Andrea Natale (A)

Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA;; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA;; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA.

Classifications MeSH