经 Amplatzer 左心耳封堵术后的单一抗血小板治疗。

Single antiplatelet therapy following Amplatzer left atrial appendage occlusion.

机构信息

Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

出版信息

EuroIntervention. 2024 Mar 4;20(5):e301-e311. doi: 10.4244/EIJ-D-23-00684.

DOI:10.4244/EIJ-D-23-00684

PMID:38436367

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10905198/

Abstract

BACKGROUND

The optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) remains debated. Ideally, this therapy should effectively prevent device-related thrombosis (DRT) while minimising the associated bleeding risk.

AIMS

We aimed to evaluate the long-term safety and efficacy of a postprocedural single antiplatelet therapy (SAPT) strategy following Amplatzer LAAO in a large consecutive cohort.

METHODS

This retrospective, single-centre, observational study included all patients discharged on SAPT after LAAO with the Amplatzer Cardiac Plug (ACP) or Amplatzer Amulet between March 2010 and December 2021 at Aarhus University Hospital, Denmark. Baseline, procedural, and imaging data were obtained locally, while clinical outcomes and medication data were extracted from the Danish national health registries.

RESULTS

A total of 553 patients underwent Amplatzer LAAO during the specified time frame. Of these, 431 (77.9%) high bleeding risk patients were discharged on SAPT with either acetylsalicylic acid (n=403, 72.9%) or clopidogrel (n=28, 5.1%). At 6 months, 173 (41.7%) patients were not on any antithrombotic therapy. The mean CHA2DS2-VASc and HAS-BLED scores were 3.9±1.5 and 3.4±1.1, respectively. DRT was detected in 6 (1.5%) patients on 8-week follow-up imaging using cardiac computed tomography (n=386, 89.6%) or transoesophageal echocardiography (n=27, 6.3%). The 1-year ischaemic stroke rate was 2.2% (95% confidence interval [CI]: 1.1-4.2). One-year rates for major bleeding and cardiovascular death were 5.9% (95% CI: 4.0-8.9) and 2.9% (95% CI: 1.6-5.1), respectively.

CONCLUSIONS

SAPT following Amplatzer LAAO displayed rates of DRT and stroke comparable to those reported with more intensive antithrombotic regimens. Meanwhile, we observed low rates of major bleeding.

摘要

背景

左心耳封堵（LAAO）术后最佳抗栓治疗仍存在争议。理想情况下，这种治疗方法应能有效预防器械相关血栓形成（DRT），同时最大限度地降低相关出血风险。

目的

我们旨在评估在丹麦奥胡斯大学医院进行的一项大型连续队列研究中，经皮左心耳封堵（LAAO）后采用单一抗血小板治疗（SAPT）策略的长期安全性和有效性。

方法

这是一项回顾性、单中心、观察性研究，纳入了 2010 年 3 月至 2021 年 12 月期间在丹麦奥胡斯大学医院接受 Amplatzer 心脏塞（ACP）或 Amplatzer 护身符封堵左心耳的患者，所有患者出院时均采用 SAPT 治疗。获得了基线、手术和影像学数据，而临床结局和药物数据则从丹麦国家健康登记处提取。

结果

在指定的时间段内，共有 553 例患者接受了 Amplatzer LAAO。其中，431 例（77.9%）高出血风险患者采用阿司匹林（n=403，72.9%）或氯吡格雷（n=28，5.1%）出院后采用 SAPT 治疗。6 个月时，173 例（41.7%）患者未服用任何抗栓药物。平均 CHA2DS2-VASc 和 HAS-BLED 评分分别为 3.9±1.5 和 3.4±1.1。8 周随访时，通过心脏计算机断层扫描（n=386，89.6%）或经食管超声心动图（n=27，6.3%）检测到 6 例（1.5%）患者存在 DRT。1 年缺血性卒中发生率为 2.2%（95%可信区间[CI]：1.1-4.2）。1 年大出血和心血管死亡发生率分别为 5.9%（95%CI：4.0-8.9）和 2.9%（95%CI：1.6-5.1）。