经皮左心耳封堵术后器械血栓与患者和操作特征相关，但与双联抗血小板治疗的植入后持续时间无关。
Device Thrombosis After Percutaneous Left Atrial Appendage Occlusion Is Related to Patient and Procedural Characteristics but Not to Duration of Postimplantation Dual Antiplatelet Therapy.
机构信息
From the Coronary and Structural Heart Diseases Department (R.P., Z.D., C.K., M.K., E.K.-D., J.P.-M., S.B., M.S., A.P., A.D., B.S., A.P., M.D.), Congenital Heart Diseases Department (M.K.), and Interventional Cardiology and Angiology Department (A.W.), Institute of Cardiology, Warsaw, Poland; Department of Medicine, New York University School of Medicine (S.B.); and Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland (W.R.).
出版信息
Circ Cardiovasc Interv. 2018 Mar;11(3):e005997. doi: 10.1161/CIRCINTERVENTIONS.117.005997.
BACKGROUND
Device-related thrombus (DRT) after left atrial appendage occlusion is a worrisome finding with little knowledge about when to expect it and how to prevent it. This study sought to investigate correlates of DRT after left atrial appendage occlusion, its time of diagnosis, and particularly, association with postimplantation dual antiplatelet therapy duration.
METHODS AND RESULTS
Consecutive patients (n=102) after left atrial appendage occlusion with AMPLATZER Cardiac Plug/Amulet (n=59) or WATCHMAN (n=43) were included in a prospective registry (October 2011-May 2016). Follow-up was done at 1.5, 3 to 6, and 12 months postimplantation. DRT was classified as early (at 1.5 month), late (at 3-6 month), or very late (at 12-month follow-up). Postimplantation dual antiplatelet therapy was recommended for 30 to 180 days and decided independently by attending physicians. Final analysis included 99 patients, 42 (42.4%) females, with median CHADS-VASc of 4.0 (interquartile range [IQR], 3.0-5.0) and median HAS-BLED score of 2.0 (IQR, 1.0-3.0). DRTs were observed in 7 (7.1%) patients: 2 (28.6%) early, 2 (28.6%) late, and 3 (42.9%) very late. When compared with patients without DRT, those with DRT presented more often with a history of prior thromboembolism (5 [71.4%] versus 28 [30.4%]; =0.04), had lower left ventricular ejection fraction (50.0 [IQR, 35.0-55.0] versus 60.0 [IQR, 55.0-66.0]; <0.01), and had greater proportion of patients with deep device implantation (6 [85.7%] versus 36 [39.1%]; =0.04) and with larger devices implanted (30.0 mm [IQR, 27.0-33.0] versus 25.0 mm [IQR, 24.0-28.0]; <0.01). Postimplantation dual antiplatelet therapy duration was not different between the 2 groups (12.4 weeks [IQR, 6.0-49.7] with DRT versus 13.0 weeks [IQR, 7.3-26.0] without DRT; =0.77).
CONCLUSIONS
In this real-world series, DRT was observed early, late, and very late after left atrial appendage occlusion. It was related to patient and procedural characteristics but not to postimplantation dual antiplatelet therapy duration.
背景
左心耳封堵术后与器械相关的血栓（DRT）是一个令人担忧的发现，目前对于何时会发生以及如何预防知之甚少。本研究旨在探讨左心耳封堵术后 DRT 的相关因素、其诊断时间，特别是与植入后双联抗血小板治疗时间的关系。
方法和结果
连续纳入 102 例接受左心耳封堵术的患者（AMPLATZER 心脏塞/Amulet 封堵器[59 例]或 WATCHMAN[43 例]），并进行前瞻性登记（2011 年 10 月至 2016 年 5 月）。植入后 1.5、3-6 和 12 个月进行随访。DRT 分为早期（植入后 1.5 个月）、晚期（植入后 3-6 个月）和极晚期（12 个月随访）。植入后双联抗血小板治疗推荐 30-180 天，由主治医生独立决定。最终分析纳入 99 例患者，42 例（42.4%）为女性，中位数 CHADS-VASc 为 4.0（四分位距[IQR]，3.0-5.0），中位数 HAS-BLED 评分为 2.0（IQR，1.0-3.0）。7 例（7.1%）患者出现 DRT：2 例（28.6%）为早期，2 例（28.6%）为晚期，3 例（42.9%）为极晚期。与无 DRT 的患者相比，有 DRT 的患者更常伴有既往血栓栓塞史（5 例[71.4%]与 28 例[30.4%]；=0.04），左心室射血分数较低（50.0[IQR，35.0-55.0]与 60.0[IQR，55.0-66.0]；<0.01），且更多患者植入较深的器械（6 例[85.7%]与 36 例[39.1%]；=0.04）和植入更大的器械（30.0mm[IQR，27.0-33.0]与 25.0mm[IQR，24.0-28.0]；<0.01）。两组植入后双联抗血小板治疗时间无差异（DRT 组 12.4 周[IQR，6.0-49.7]与无 DRT 组 13.0 周[IQR，7.3-26.0]；=0.77）。
结论
在本真实世界系列研究中，左心耳封堵术后 DRT 可早期、晚期和极晚期发生。它与患者和手术特征有关，但与植入后双联抗血小板治疗时间无关。
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