Department of Cardiology, Ren Ji Hospital, 71140Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pharmacy, Ren Ji Hospital, 71140Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Sci Prog. 2022 Jul-Sep;105(3):368504221113194. doi: 10.1177/00368504221113194.
Percutaneous left atrial appendage occlusion (LAAO) provides an alternative for poor candidates for long-term oral anticoagulation (OAC). To prevent device-related thrombosis (DRT), OAC should be continued for the first 45 days to allow complete endothelialization post-LAAO implantation. Whereas, evidence is limited on the feasibility and safety of direct oral anticoagulants (DOACs) used after LAAO.
This was a retrospective observational single-center study of AF patients undergoing LAAO with a Watchman device and receiving either low-dose dabigatran (110mg twice daily) or warfarin in the peri- and post-procedural period for 45 days. Transesophageal echocardiography was scheduled to perform at 6 weeks, 6 months, and 12 months after the procedure to assess the stability of the device and to detect DRT. Incidence of thromboembolic and bleeding events were also evaluated during the follow-up period.
There were a total of 84 patients who successfully underwent Watchman implantation, with 38 patients (45.2%) receiving low-dose dabigatran and 46 patients (54.8%) using warfarin post-LAAO. Peri-procedural complications occurred in 10 patients, with 3 patients in the dabigatran group and 7 patients in the warfarin group (7.9% vs. 15.2%, = 0.30). During the 12-month follow-up, 1 patient experienced major bleeding and 16 patients suffered minor bleeding in the warfarin group, while 5 patients treated with dabigatran had minor bleeding (34.8% vs. 13.2%, = 0.02). Besides, 6 DRT (15.8%) were detected in dabigatran groups, and the incidence was higher than in the warfarin group (15.8% vs. 2.2%, = 0.03). No DRT-related ischemic events were found.
This study suggested that short-term low-dose dabigatran (110 mg twice daily) could significantly decrease the risk of bleeding compared with warfarin at the expense of increased risk of DRT post-LAAO. Therefore, low-dose dabigatran should be used with caution for post-implant anticoagulation of LAAO. Further studies are urgently needed on the feasibility and safety of DOACs post-LAAO.
经皮左心耳封堵术（LAAO）为长期口服抗凝治疗（OAC）禁忌的患者提供了一种替代方法。为了预防器械相关血栓形成（DRT），LAAO 后应继续 OAC 治疗 45 天，以允许 LAAO 植入后完全内皮化。然而，关于 LAAO 后使用直接口服抗凝剂（DOACs）的可行性和安全性的证据有限。
这是一项回顾性观察性单中心研究，纳入了接受 Watchman 装置行 LAAO 的 AF 患者，并在围手术期和术后 45 天内分别接受低剂量达比加群（110mg，每日 2 次）或华法林治疗。术后 6 周、6 个月和 12 个月行经食管超声心动图检查，以评估器械稳定性和检测 DRT。在随访期间还评估了血栓栓塞和出血事件的发生率。
共有 84 例患者成功接受 Watchman 植入术，其中 38 例（45.2%）患者术后接受低剂量达比加群治疗，46 例（54.8%）患者接受华法林治疗。围手术期并发症发生于 10 例患者，达比加群组 3 例，华法林组 7 例（7.9%比 15.2%， = 0.30）。在 12 个月的随访期间，华法林组有 1 例患者发生大出血，16 例患者发生小出血，而达比加群组有 5 例患者发生小出血（34.8%比 13.2%， = 0.02）。此外，达比加群组有 6 例 DRT（15.8%），高于华法林组（15.8%比 2.2%， = 0.03）。未发现与 DRT 相关的缺血事件。
本研究表明，与华法林相比，LAAO 术后短期应用低剂量达比加群（110mg，每日 2 次）可显著降低出血风险，但会增加 DRT 风险。因此，LAAO 后应用达比加群应谨慎。迫切需要进一步研究 LAAO 后 DOACs 的可行性和安全性。
