Garot Philippe, Cepas-Guillén Pedro, Flores-Umanzor Eduardo, Leduc Nina, Bajoras Vilhemas, Perrin Nils, McInerney Angela, Lafond Ana, Farjat-Pasos Julio, Millán Xavi, Zendjebil Sandra, Ibrahim Reda, Salinas Pablo, de Backer Ole, Cruz-González Ignacio, Arzamendi Dabit, Sanchis Laura, Nombela-Franco Luis, ÓHara Gilles, Aminian Adel, Nielsen-Kudsk Jens Erik, Rodés-Cabau Josep, Freixa Xavier
Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France.
Institut Clínic Cardiovascular (ICCV), Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Interventional Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada. Electronic address: https://x.com/@pedro_cepas.
Rev Esp Cardiol (Engl Ed). 2025 Aug;78(8):668-678. doi: 10.1016/j.rec.2024.11.006. Epub 2024 Dec 5.
The optimal antithrombotic therapy (AT) after left atrial appendage closure (LAAC) is debated. We assessed the impact of intensive vs nonintensive AT on the incidence of device-related thrombus (DRT) based on whether the device implantation was classified as optimal or suboptimal.
This study included patients who underwent successful LAAC in 9 centers. Patients were classified according to the quality of device implantation: optimal (proximal implant without ≥3mm peridevice leak) or suboptimal (distal implant and/or ≥3mm peridevice leak). Postimplant AT was classified as either intensive (dual antiplatelet therapy, anticoagulants, or a combination of both) or nonintensive (no AT or a single antiplatelet therapy). The primary endpoint was the incidence of DRT between the 6th and 12th weeks postprocedure.
A total of 1225 patients underwent LAAC, with 757 (61.8%) achieving optimal device implantation and 468 (38.2%) classified as suboptimal. After a median follow-up of 20 months, the incidence of DRT in the optimal implant group was 2.6% with intensive AT and 3.7% with nonintensive AT (P=.38). In the suboptimal implant group, the incidence of DRT increased to 11.2% with intensive AT and 15.5% with nonintensive AT (P=.19). On multivariate analysis, suboptimal implantation (HR, 4.51; 95%CI, 2.70-7.54, P<.001) but not intensive AT (HR, 0,66; 95%CI, 0.40-1.07, P=.09) emerged as an independent predictor of DRT.
The incidence of DRT after LAAC was higher in patients with suboptimal device implantation. In patients with optimal implantation, the incidence of DRT was low and similar between nonintensive and intensive AT strategies. Large, randomized trials are warranted to confirm these results.
左心耳封堵术（LAAC）后最佳抗栓治疗（AT）存在争议。我们根据器械植入被分类为最佳或次优，评估了强化与非强化AT对器械相关血栓（DRT）发生率的影响。
本研究纳入了在9个中心成功接受LAAC的患者。患者根据器械植入质量分类：最佳（近端植入且器械周围渗漏<3mm）或次优（远端植入和/或器械周围渗漏≥3mm）。植入后AT分为强化（双联抗血小板治疗、抗凝治疗或两者联合）或非强化（无AT或单一抗血小板治疗）。主要终点是术后第6至12周DRT的发生率。
共有1225例患者接受了LAAC，其中757例（61.8%）实现了最佳器械植入，468例（38.2%）被分类为次优。中位随访20个月后，最佳植入组中强化AT时DRT发生率为2.6%，非强化AT时为3.7%（P = 0.38）。在次优植入组中，强化AT时DRT发生率增至11.2%，非强化AT时为15.5%（P = 0.19）。多因素分析显示，次优植入（HR，4.51；95%CI，2.70 - 7.54，P<0.001）而非强化AT（HR，0.66；95%CI，0.40 - 1.07，P = 0.09）是DRT的独立预测因素。
器械植入次优的患者LAAC后DRT发生率较高。在植入最佳的患者中，DRT发生率较低，非强化和强化AT策略之间相似。需要大型随机试验来证实这些结果。
