Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California, USA.
J Am Coll Cardiol. 2024 Sep 3;84(10):889-900. doi: 10.1016/j.jacc.2024.05.067.
The prevalence of and outcomes associated with different antithrombotic strategies after left atrial appendage occlusion (LAAO) are not well described.
This study sought to evaluate patterns of antithrombotic medication strategies at discharge following LAAO with the Watchman FLX device in real-world practice and to compare the risk of adverse events among the different antithrombotic regimens.
The authors evaluated patients in the NCDR (National Cardiovascular Data Registry) LAAO Registry who underwent LAAO with the second-generation LAA closure device between 2020 and 2022. They grouped patients by mutually exclusive discharge antithrombotic strategies and compared the rates of adverse events at 45 days and 6 months using multivariable Cox proportional hazards regression.
Among 53,878 patients undergoing successful LAAO with the second-generation LAA closure device, the most common antithrombotic discharge regimens were direct oral anticoagulant (DOAC) plus aspirin (48.3%), DOAC alone (22.6%), dual antiplatelet therapy (8.1%), warfarin plus aspirin (7.7%), and DOAC plus P2Y inhibitor (4.9%). In multivariate analysis, DOAC alone had a lower rate of major adverse events and major bleeding at 45 days of follow-up compared with DOAC plus aspirin (major adverse events: HR: 0.78; 95% CI: 0.68-0.91; major bleeding: HR: 0.69; 95% CI: 0.60-0.80). These differences persisted at 6 months. Warfarin without aspirin also showed lower rates of major bleeding at both time points. No differences were seen in stroke/transient ischemic attack or device-related thrombus.
In real-world U.S. practice, discharge on DOAC alone or warfarin alone was associated with a lower rate of adverse events compared with DOAC plus aspirin.
左心耳封堵（LAAO）后不同抗栓策略的流行情况及其相关结局尚不清楚。
本研究旨在评估真实世界中使用 Watchman FLX 装置行 LAAO 后出院时的抗栓药物策略模式，并比较不同抗栓方案的不良事件风险。
研究者评估了 2020 年至 2022 年期间在 NCDR（国家心血管数据注册中心）LAAO 注册中心接受第二代 LAA 封堵装置行 LAAO 的患者。他们将患者按相互排斥的出院抗栓策略分组，并使用多变量 Cox 比例风险回归比较 45 天和 6 个月时的不良事件发生率。
在 53878 例行第二代 LAA 封堵装置成功 LAAO 的患者中，最常见的出院抗栓方案是直接口服抗凝剂（DOAC）加阿司匹林（48.3%）、DOAC 单药治疗（22.6%）、双联抗血小板治疗（8.1%）、华法林加阿司匹林（7.7%）和 DOAC 加 P2Y 抑制剂（4.9%）。多变量分析显示，与 DOAC 加阿司匹林相比，DOAC 单药治疗在 45 天随访时主要不良事件和主要出血的发生率较低（主要不良事件：HR：0.78；95%CI：0.68-0.91；主要出血：HR：0.69；95%CI：0.60-0.80）。这些差异在 6 个月时仍然存在。华法林无阿司匹林治疗在两个时间点也显示出较低的大出血发生率。在卒中/短暂性脑缺血发作或器械相关血栓形成方面没有差异。
在真实世界的美国实践中，与 DOAC 加阿司匹林相比，单独使用 DOAC 或华法林与较低的不良事件发生率相关。
