经皮左心耳封堵术后抗栓治疗方案 - 一项真实世界研究。
Antithrombotic Regimen After Percutaneous Left Atrial Appendage Closure - A Real-World Study.
机构信息
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine.
Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine.
出版信息
Circ J. 2023 Nov 24;87(12):1820-1827. doi: 10.1253/circj.CJ-22-0687. Epub 2023 Jun 20.
BACKGROUND
Antithrombotic therapy after left atrial appendage closure (LAAC) in patients at high risk of bleeding remains controversial. We present real-world clinical outcomes of LAAC.
METHODS AND RESULTS
Data from 74 consecutive patients who received LAAC therapy between January 2020 and June 2022 were analyzed. Patients received 1 of 3 antithrombotic therapies according to the bleeding risk category or clinical event. Regimen 1 was based on a prior study, regimen 2 comprised a lower antiplatelet drug dose without dual antiplatelet therapy, and regimen 3 was antiplatelet drug administration for as long as possible to patients with uncontrollable bleeding who were required to stop anticoagulant drugs. Overall, 73 (98.6%) procedures were successful. Of them, 16 (21.9%) patients were selected for regimen 1, 46 (63.0%) for regimen 2, and 11 (15.1%) for regimen 3. Device-related thrombosis (13% vs. 0% vs. 0%, P=0.0257) only occurred with regimen 1. There was no difference in major bleeding event rates (6% vs. 2% vs. 9%, P=0.53).
CONCLUSIONS
The post-LAAC antithrombotic regimen was modified without major concerns.
背景
在出血风险较高的患者中，左心耳封堵（LAAC）术后的抗血栓治疗仍存在争议。我们报告了 LAAC 的真实世界临床结局。
方法和结果
分析了 2020 年 1 月至 2022 年 6 月期间接受 LAAC 治疗的 74 例连续患者的数据。根据出血风险类别或临床事件，患者接受了 3 种抗血栓治疗方案中的 1 种。方案 1 基于先前的研究，方案 2 包括较低剂量的抗血小板药物而不进行双联抗血小板治疗，方案 3 是对有不可控制出血的患者尽可能长时间地使用抗血小板药物，这些患者需要停止抗凝药物。总体而言，73 例（98.6%）手术成功。其中，16 例（21.9%）患者选择方案 1，46 例（63.0%）患者选择方案 2，11 例（15.1%）患者选择方案 3。仅方案 1发生器械相关血栓形成（13%比 0%比 0%，P=0.0257）。大出血事件发生率无差异（6%比 2%比 9%，P=0.53）。
结论
LAAC 术后的抗血栓治疗方案在没有出现严重问题的情况下进行了调整。
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