Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Rheinische-Friedrich-Wilhelms Universität Bonn, Bonn, Germany.
Medizinische Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Rheinische-Friedrich-Wilhelms Universität Bonn, Bonn, Germany.
JACC Clin Electrophysiol. 2017 Jan;3(1):71-75. doi: 10.1016/j.jacep.2016.05.006. Epub 2016 Jul 27.
This study sought to define the ideal post-procedural anticoagulant regime and to systematically study the incidence of device-related thrombus.
Left atrial appendage occlusion (LAAo) is an alternative to life-long oral anticoagulation in selected patients with atrial fibrillation.
This study included 24 atrial fibrillation patients (ages 79 ± 8 years; 75% male, CHADSVASc [Congestive Heart Failure, Hypertension, Age ≥75 Years, Diabetes Mellitus, Previous Stroke or Transient Ischemic Attack or Thromboembolism, Vascular Disease, Age 65 to 74 Years. Sex] score: 4.3 ± 1.5, HAS-BLED [Hypertension, Abnormal Renal and Liver Function, Stroke, Bleeding, Labile International Normalized Ratio, Elderly, Drugs or Alcohol] score: 3.6 ± 0.8) after LAAo with the use of the Amplatzer Amulet system. Dual antiplatelet therapy for 3 months was prescribed in 95.6% of the cases.
Transesophageal echocardiography identified a high rate of device adherent thrombi (16.7%, n = 4 of 23) after a mean of 11.0 ± 8.2 weeks. Thrombus formation occurred under dual antiplatelet therapy (3 of 4) or clopidogrel monotherapy (1 of 4). When compared with patients without thrombi, echocardiography showed higher degrees of spontaneous echo contrast grades within the LAA (3.0 ± 1.0 vs. 1.3 ± 1.1), lower LAA peak emptying velocities (17.5 ± 5.0 cm/s vs. 48.3 ± 21.1 cm/s), and decreased left ventricular function (39 ± 10% vs. 50 ± 13%) in patients with device-related thrombus. All thrombi were observed within the untrabeculated region of the LAA ostium between the left upper pulmonary vein ridge and the occluder disc, indicating suboptimal LAA occlusion.
Device-related thrombus is a frequent finding after LAAo with the Amplatzer Amulet device (St. Jude Medical, St. Paul, Minnesota). Our results emphasize the need for an optimized post-LAAo anticoagulation regimen, a revised implantation strategy, and possibly modified patient selection criteria.
本研究旨在确定理想的术后抗凝方案，并系统研究与器械相关的血栓形成的发生率。
左心耳封堵术（LAAo）是一种替代方法，可用于某些有房颤病史的患者，以替代终身口服抗凝治疗。
本研究纳入了 24 例房颤患者（年龄 79 ± 8 岁；75%为男性，CHADSVASc[充血性心力衰竭、高血压、年龄≥75 岁、糖尿病、既往卒中和短暂性脑缺血发作或血栓栓塞、血管疾病、年龄 65 岁至 74 岁]评分：4.3 ± 1.5，HAS-BLED[高血压、肾功能和肝功能异常、卒中和血栓栓塞、出血、国际标准化比值不稳定、高龄、药物或酒精]评分：3.6 ± 0.8），使用 Amplatzer Amulet 系统进行 LAAo 治疗。95.6%的患者在术后 3 个月内接受双联抗血小板治疗。
平均 11.0 ± 8.2 周后，经食管超声心动图发现有较高的器械相关血栓形成率（16.7%，n=23 例中的 4 例）。血栓形成发生在双联抗血小板治疗（3/4）或氯吡格雷单药治疗（1/4）期间。与无血栓形成的患者相比，超声心动图显示 LAA 内自发性回声对比程度较高（3.0 ± 1.0 比 1.3 ± 1.1），LAA 峰值排空速度较低（17.5 ± 5.0 cm/s 比 48.3 ± 21.1 cm/s），左心室功能降低（39 ± 10%比 50 ± 13%）。所有血栓均位于左肺上静脉嵴和封堵器盘之间的 LAA 开口无小梁区，表明 LAA 封堵不完全。
在使用 Amplatzer Amulet 装置（圣犹达医疗公司，明尼苏达州圣保罗）进行 LAAo 后，器械相关血栓形成是一种常见的发现。我们的研究结果强调了需要优化 LAAo 后抗凝方案、修订植入策略，并可能需要修改患者选择标准。
