Kim Myung-Rho, Dugal Jasmine, Wang Shawn, Taylor Spencer, Goel Vidhani, Shafi Amaan, Singh Aditi, Batra Kavita
Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV.
Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV.
Medicine (Baltimore). 2025 Jun 20;104(25):e42885. doi: 10.1097/MD.0000000000042885.
Antithrombotic therapy following left atrial appendage occlusion (LAAO) is recommended to prevent device-induced thrombosis and stroke. Guidelines suggest oral anticoagulants and aspirin for the first 45 days and then dual antiplatelet therapy for 6 months. However, regimens for antithrombotic therapy varies widely. This study aimed to assess the characteristics of patients receiving minimal versus standard antithrombotic therapy post-LAAO, and to examine the association between treatment type and thrombotic/bleeding risk scores. We conducted a retrospective observational study of patients who underwent LAAO at a teaching hospital between April and December 2023. Patients were categorized into minimal (DOAC only) or standard (DOAC plus aspirin) therapy groups during the first 45 days, and into minimal (SAPT) or standard (DAPT) groups from 45 days to 6 months. Outcomes included CHA2DS2-VASc and HAS-BLED scores, comorbidities, and bleeding/thrombotic events. Statistical analyses included univariate and bivariate comparisons using Chi-square, Fisher exact test, and t-tests. Among 33 patients, 82% received minimal therapy and 18% for the standard therapy in the first 45 days. Standard therapy patients had higher rates of transient ischemic attack (50% vs 7.5%), stroke (100% vs 37%), coronary artery disease (100% vs 44.4%), and NSAID use (33.3% vs 3.7%, P < .05). The CHA2DS2-VASc scores were significantly higher in the standard group (6.5 ± 0.5 vs 4.6 ± 1.4, P = .002), with no difference in HAS-BLED scores. From 45 days to 6 months, 15.2% received minimal and 84.8% for the standard therapy, with no significant differences in scores. Patients with lower CHA2DS2-VASc scores were more likely to receive minimal therapy, indicating potential for risk-guided antithrombotic management post-LAAO. Further studies are needed to validate individualized treatment strategies.
推荐在左心耳封堵术（LAAO）后进行抗栓治疗，以预防器械诱导的血栓形成和中风。指南建议在最初45天使用口服抗凝剂和阿司匹林，然后在6个月内进行双联抗血小板治疗。然而，抗栓治疗方案差异很大。本研究旨在评估LAAO术后接受最小化与标准化抗栓治疗患者的特征，并检验治疗类型与血栓形成/出血风险评分之间的关联。我们对2023年4月至12月在一家教学医院接受LAAO的患者进行了一项回顾性观察研究。患者在最初45天被分为最小化（仅使用直接口服抗凝剂）或标准化（直接口服抗凝剂加阿司匹林）治疗组，在45天至6个月期间分为最小化（单联抗血小板治疗）或标准化（双联抗血小板治疗）组。结局指标包括CHA2DS2-VASc和HAS-BLED评分、合并症以及出血/血栓形成事件。统计分析包括使用卡方检验、Fisher精确检验和t检验进行单变量和双变量比较。在33例患者中，82%在最初45天接受最小化治疗，18%接受标准化治疗。接受标准化治疗的患者短暂性脑缺血发作（50%对7.5%）、中风（100%对37%）、冠状动脉疾病（100%对44.4%）和使用非甾体抗炎药（33.3%对3.7%，P<0.05）的发生率更高。标准化治疗组的CHA2DS2-VASc评分显著更高（6.5±0.5对4.6±1.4，P=0.002）,HAS-BLED评分无差异。在45天至6个月期间，15.2%接受最小化治疗，84.8%接受标准化治疗，评分无显著差异。CHA2DS2-VASc评分较低的患者更有可能接受最小化治疗，这表明LAAO术后进行风险导向的抗栓管理具有可能性。需要进一步研究来验证个体化治疗策略。
