Galea Roberto, Krsnik Juan Perich, Bini Tommaso, Chalkou Konstantina, Gasys Antanas, Brugger Nicolas, Madhkour Raouf, Seiffge David Julian, Roten Laurent, Siontis George C M, Räber Lorenz
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Cardiology, Hospital Centre of Biel, Biel, Switzerland.
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Heart Rhythm. 2025 Apr;22(4):971-978. doi: 10.1016/j.hrthm.2024.12.007. Epub 2025 Jan 3.
Dual antiplatelet therapy and oral anticoagulation in combination with aspirin represent recommended treatment regimens after left atrial appendage closure (LAAC). As most patients receiving LAAC have high bleeding risk, less aggressive antithrombotic treatments are needed, such as single antiplatelet therapy.
We sought to compare both ischemic and bleeding outcomes in patients receiving single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) after successful LAAC.
Data on consecutive patients undergoing percutaneous LAAC between 2009 and 2023 were prospectively collected including 1-year follow-up. Propensity score matching was performed for patients discharged under SAPT and DAPT. The primary end point was the 1-year composite of cardiovascular death, stroke, systemic embolism, or device-related thrombosis (DRT). The secondary end points included major bleeding and DRT.
Of 1033 patients discharged with antiplatelet therapy, 154 patients receiving SAPT were compared with 230 matched patients receiving DAPT. The primary end point was similar between the study groups (SAPT 11.0% vs DAPT 8.3%; rate ratio, 1.14; 95% confidence interval [CI], 0.83-1.55; P = .420). Consistently, we found no difference in terms of both major bleeding (SAPT 9.7% vs DAPT 12.6%; hazard ratio, 0.77; 95% CI, 0.43-1.39; P = .387) and DRT (2.6% vs 1.1%; rate ratio, 1.47; 95% CI, 0.89-2.43; P = .130) between the SAPT and DAPT groups.
In this propensity score matching analysis of a single-center LAAC cohort, ischemic and bleeding outcomes did not differ at 1 year for patients discharged with SAPT or DAPT. These results have to be confirmed in an adequately powered randomized clinical trial.
双重抗血小板治疗以及联合阿司匹林的口服抗凝治疗是左心耳封堵术（LAAC）后推荐的治疗方案。由于大多数接受LAAC的患者出血风险较高，因此需要采用较温和的抗栓治疗，如单一抗血小板治疗。
我们旨在比较成功进行LAAC后接受单一抗血小板治疗（SAPT）或双重抗血小板治疗（DAPT）的患者的缺血和出血结局。
前瞻性收集2009年至2023年间连续接受经皮LAAC患者的数据，包括1年随访。对接受SAPT和DAPT出院的患者进行倾向评分匹配。主要终点是心血管死亡、中风、全身性栓塞或器械相关血栓形成（DRT）的1年复合终点。次要终点包括大出血和DRT。
在1033例接受抗血小板治疗出院的患者中，将154例接受SAPT的患者与230例匹配的接受DAPT的患者进行比较。研究组之间的主要终点相似（SAPT为11.0%，DAPT为8.3%；率比为1.14；95%置信区间[CI]为0.83-1.55；P = 0.420）。同样，我们发现SAPT组和DAPT组在大出血（SAPT为9.7%，DAPT为12.6%；风险比为0.77；95%CI为0.43-1.39；P = 0.387）和DRT（2.6%对1.1%；率比为1.47；95%CI为0.89-2.43；P = 0.130）方面均无差异。
在这项对单中心LAAC队列的倾向评分匹配分析中，接受SAPT或DAPT出院的患者在1年时缺血和出血结局无差异。这些结果必须在一项有足够效力的随机临床试验中得到证实。
