Early Discontinuation of Antithrombotic Treatment Following Left Atrial Appendage Closure.

Abstract

Although antithrombotic treatment is recommended after left atrial appendage closure (LAAC), some patients require discontinuation of antithrombotic treatment after LAAC without evidence on the safety of such a strategy. We sought to evaluate outcomes of patients who had early antithrombotic treatment discontinuation after LAAC. This is a multicenter study including 1,082 patients who underwent successful LAAC. Early discontinuation of antithrombotic treatment was defined as discontinuation of all antiplatelet/anticoagulant treatment within 6 months following the procedure. A propensity-matched analysis was used to compare outcomes of patients with and without early antithrombotic treatment discontinuation. A total of 148 patients (13.7%) had early antithrombotic treatment discontinuation. In the entire population, antithrombotic treatment discontinuation patients exhibited a lower CHA2DS2-VASc score (p <0.001) and a higher rate of previous gastrointestinal bleeding episodes (p = 0.01) compared with patients without discontinuation. After a median follow-up of 2.1 (1,1-3.1) years after antithrombotic treatment discontinuation, the rates of death, ischemic stroke, and major bleeding were 12.1, 0.6, and 3.3 per 100 patient-years. In 119 matched pairs with similar baseline characteristics, antithrombotic treatment discontinuation patients had a similar risk of death (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.65 to 1.71, p = 0.82), ischemic stroke (HR 0.39, 95% CI 0.04 to 3.79, p = 0.42) and major bleeding (HR 1.48, 95% CI 0.56 to 3.88, p = 0.43) compared with those without discontinuation. In conclusion, antithrombotic treatment was discontinued in 1 of 7 selected patients within 6 months after LAAC, and this was not associated with an increased risk of death or thromboembolic events after a median follow-up of 2 years. These data support the safety of shorter periods of antithrombotic therapy after LAAC in high bleeding risk patients based on clinician judgment. Further trials are warranted.

• Authors: Jules Mesnier, Ignacio Cruz-González, Dabit Arzamendi, Xavier Freixa, Luis Nombela-Franco, Vicente Peral, Berenice Caneiro-Queija, Antonio Mangieri, Blanca Trejo-Velasco, Lluis Asmarats, Ander Regueiro, Angela McInerney, Caterina Mas-Lladó, Rodrigo Estevez-Loureiro, Alessandra Laricchia, Gilles O'Hara, Josep Rodés-Cabau
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 171 Pg. 91-98 (05 15 2022) ISSN: 1879-1913 [Electronic] United States
• PMID: 35317927 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Chemical References

• Fibrinolytic Agents

Topics

• Atrial Appendage (surgery)
• Atrial Fibrillation (complications, drug therapy)
• Fibrinolytic Agents (therapeutic use)
• Hemorrhage (epidemiology)
• Humans
• Ischemic Stroke
• Stroke (epidemiology, etiology, prevention & control)
• Treatment Outcome