Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany.
EuroIntervention. 2018 Apr 6;13(18):e2138-e2146. doi: 10.4244/EIJ-D-17-00901.
We aimed to assess the feasibility, efficacy and safety of short-term dual antiplatelet therapy (DAPT) for six weeks after left atrial appendage closure (LAAC).
Data of the Cardioangiologisches Centrum Bethanien-LAAC registry were analysed. DAPT (aspirin 100 mg plus clopidogrel 75 mg) was administered until transoesophageal echocardiography (TEE) evaluation six weeks after LAAC. In the absence of significant peri-device flow or device-related thrombus (DRT), the medication was decreased to single antiplatelet therapy (SAPT). Outpatient visits were timed at six-month intervals. The incidences of major bleeding (BARC ≥3) and of thromboembolic events were investigated. A total of 298 patients (76±8 years; 62% male; CHA2DS2-VASc 4.3±1.5; HAS-BLED 3.5±1.0; 61% with history of bleeding) with successful LAAC were included. TEE revealed DRT in 7/298 (2.3%) patients (five at six-week follow-up [FU] 45±10 days after implant, two during a median long-term FU of 731 days). Non-procedure-related bleeding events occurred in 25/298 (8.4%) patients and non-procedure-related thromboembolic events in 11/298 (3.7%) patients. This translated into 3.9 bleeding events/100 patient-years and 1.7 thromboembolic events/100 patient-years, respectively. Procedure-related events consisted of major bleeding in 7/298 (2.3%) patients and stroke in 2/298 (0.7%) patients. Age ≥75 years (OR 3.2; CI: 1.2-8.0; p=0.015) and renal impairment (OR 2.5; CI: 1.1-5.7; p=0.027) were identified as independent predictors for major bleeding after LAAC.
Short-term DAPT for six weeks appears to be a viable alternative for patients after LAAC. Age ≥75 years and renal impairment increase major bleeding events threefold.
我们旨在评估左心耳封堵（LAAC）后六周短期双联抗血小板治疗（DAPT）的可行性、疗效和安全性。
对 Cardioangiologisches Centrum Bethanien-LAAC 注册中心的数据进行了分析。DAPT（阿司匹林 100mg 加氯吡格雷 75mg）在 LAAC 后 6 周进行经食管超声心动图（TEE）评估时给予。在无明显器械周围血流或器械相关血栓（DRT）的情况下，药物减少至单药抗血小板治疗（SAPT）。门诊随访时间间隔为 6 个月。调查了主要出血（BARC≥3）和血栓栓塞事件的发生率。共纳入 298 例（76±8 岁；62%为男性；CHA2DS2-VASc 4.3±1.5；HAS-BLED 3.5±1.0；61%有出血史）LAAC 成功的患者。TEE 显示 298 例中有 7/298 例（2.3%）患者存在 DRT（五例在植入后 45±10 天的 6 周随访时，两例在中位数为 731 天的长期随访期间）。298 例中有 25/298（8.4%）例患者发生非手术相关出血事件，11/298（3.7%）例患者发生非手术相关血栓栓塞事件。这分别转化为 3.9 出血事件/100 患者年和 1.7 血栓栓塞事件/100 患者年。手术相关事件包括 298 例中有 7/298 例（2.3%）患者发生大出血和 2/298 例（0.7%）患者发生中风。年龄≥75 岁（OR 3.2；95%CI：1.2-8.0；p=0.015）和肾功能不全（OR 2.5；95%CI：1.1-5.7；p=0.027）被确定为 LAAC 后发生大出血的独立预测因素。
LAAC 后六周的短期 DAPT 似乎是一种可行的替代方案。年龄≥75 岁和肾功能不全使大出血事件增加三倍。
