Ledwoch Jakob, Sievert Kolja, Boersma Lucas V A, Bergmann Martin W, Ince Hüseyin, Kische Stephan, Pokushalov Evgeny, Schmitz Thomas, Schmidt Boris, Gori Tommaso, Meincke Felix, Protopopov Alexey Vladimir, Betts Timothy R, Mazzone Patrizio, Foley David, Grygier Marek, De Potter Tom, Sievert Horst
CardioVascular Center CVC, Seckbacher Landstraße 65, 60389 Frankfurt, Germany.
Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, München Klinik Neuperlach, Munich, Germany.
Europace. 2020 Jul 1;22(7):1036-1043. doi: 10.1093/europace/euaa074.
Evidence regarding post-procedural antithrombotic regimen other than used in randomized trials assessing percutaneous left atrial appendage (LAA) closure is limited. The present work aimed to compare different antithrombotic strategies applied in the real-world EWOLUTION study.
A total of 998 patients with successful WATCHMAN implantation were available for the present analysis. The composite ischaemic endpoint of stroke, transitory ischaemic attack, systemic embolism and device thrombus, and the bleeding endpoint defined as at least major bleeding were assessed during an initial period (from implant until first medication change) and long-term period (from first change up to 2 years). The antithrombotic medication chosen in the initial phase was dual antiplatelet therapy (DAPT) in 60%, oral anticoagulation (OAC) in 27%, single antiplatelet therapy (SAPT) in 7%, and no medication in 6%. In the second long-term phase, SAPT was used in 65%, DAPT in 23%, no therapy in 8%, and OAC in 4%. No significant differences were found between the groups regarding the ischaemic endpoint both in the initial period (Kaplan-Meier estimated rate 2.9% for DAPT vs. 4.3% for OAC vs. 3.9% for SAPT or no therapy) and in the second period (4.2% for SAPT vs. 1.8% for DAPT vs. 3.5% for no therapy). With respect to bleeding events, the only difference was found in the initial phase with a higher incidence in patients under SAPT or no therapy.
Tailored antithrombotic treatment using even very reduced strategies such as SAPT or no therapy showed no significant differences regarding ischaemic complications after LAA closure.
除了在评估经皮左心耳（LAA）封堵术的随机试验中所采用的方案外，关于术后抗血栓治疗方案的证据有限。本研究旨在比较在真实世界的EWOLUTION研究中应用的不同抗血栓策略。
本分析共纳入998例成功植入WATCHMAN的患者。在初始阶段（从植入至首次药物变更）和长期阶段（从首次变更至2年）评估复合缺血终点（卒中、短暂性脑缺血发作、全身性栓塞和器械血栓）以及定义为至少发生一次大出血的出血终点。初始阶段选择的抗血栓药物中，60%为双联抗血小板治疗（DAPT），27%为口服抗凝治疗（OAC），7%为单联抗血小板治疗（SAPT），6%未用药。在第二个长期阶段，65%使用SAPT，23%使用DAPT，8%未治疗，4%使用OAC。在初始阶段（DAPT的Kaplan-Meier估计发生率为2.9%，OAC为4.3%，SAPT或未治疗为3.9%）和第二阶段（SAPT为4.2%，DAPT为1.8%，未治疗为3.5%），各治疗组之间的缺血终点无显著差异。关于出血事件，仅在初始阶段发现差异，接受SAPT或未治疗的患者出血发生率较高。
采用如SAPT或未治疗等甚至非常简化的策略进行个体化抗血栓治疗，在LAA封堵术后的缺血并发症方面无显著差异。
