Low Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion

The optimal antithrombotic strategy following left atrial appendage occlusion (LAAO) is not yet clearly established. Low-dose non-vitamin K antagonist oral anticoagulants (NOAC) might represent a valid alternative, but data regarding their usage is scarce. The aim of this study was to examine the ef...

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Autores principales:	Pedro Luis Cepas-Guillen, Eduardo Flores-Umanzor, Ander Regueiro, Salvatore Brugaletta, Cristina Ibañez, Laura Sanchis, Marta Sitges, Josep Rodés-Cabau, Manel Sabaté, Xavier Freixa
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	atrial fibrillation non-vitamin K antagonist oral anticoagulants left atrial appendage occlusion bleeding Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/5dfc3a33d4c74b4a9dab82beb028805c
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spelling	oai:doaj.org-article:5dfc3a33d4c74b4a9dab82beb028805c2021-11-25T18:00:16ZLow Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion10.3390/jcdd81101422308-3425https://doaj.org/article/5dfc3a33d4c74b4a9dab82beb028805c2021-10-01T00:00:00Zhttps://www.mdpi.com/2308-3425/8/11/142https://doaj.org/toc/2308-3425The optimal antithrombotic strategy following left atrial appendage occlusion (LAAO) is not yet clearly established. Low-dose non-vitamin K antagonist oral anticoagulants (NOAC) might represent a valid alternative, but data regarding their usage is scarce. The aim of this study was to examine the efficacy and safety of low-dose NOAC compared to single (SAPT) or dual antiplatelet therapies (DAPT) after LAAO. We included consecutive patients with non-valvular atrial fibrillation who underwent LAAO and received low-dose apixaban, SAPT, or DAPT at discharge. The primary objective of this study included an efficacy endpoint (thromboembolic events and device related thrombosis (DRT)) and a safety endpoint (incidence of major bleeding) within the first three months after LAAO. A total of 139 patients were included. This group involved SAPT in 26 (18%), DAPT in 73 (53%), and apixaban in 40 (29%) patients. Follow-up at three-months showed no significant differences in the primary efficacy endpoint (2 (8%) SAPT, 3 (4%) DAPT and 0 (0%) apixaban; <i>p</i> value = 0.25). In contrast, the primary safety endpoint occurred more frequently in DAPT patients (7 (10%) DAPT, 0 (0%), SAPT and 0 with apixaban; <i>p</i> value = 0.03). Combining both efficacy and safety outcomes, low dose apixaban had a lower rate of events (2 (8%) with SAPT, 9 (12%) with DAPT and 0 (0%) with apixaban; <i>p</i> = 0.046). Low-dose apixaban after LAAO may be a valid alternative to DAPT and SAPT as depicted by the reduction in the occurrence of major bleedings and combined DRT/major bleedings respectively. Randomized data will be necessary to validate this strategy.Pedro Luis Cepas-GuillenEduardo Flores-UmanzorAnder RegueiroSalvatore BrugalettaCristina IbañezLaura SanchisMarta SitgesJosep Rodés-CabauManel SabatéXavier FreixaMDPI AGarticleatrial fibrillationnon-vitamin K antagonist oral anticoagulantsleft atrial appendage occlusionbleedingDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of Cardiovascular Development and Disease, Vol 8, Iss 142, p 142 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation non-vitamin K antagonist oral anticoagulants left atrial appendage occlusion bleeding Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	atrial fibrillation non-vitamin K antagonist oral anticoagulants left atrial appendage occlusion bleeding Diseases of the circulatory (Cardiovascular) system RC666-701 Pedro Luis Cepas-Guillen Eduardo Flores-Umanzor Ander Regueiro Salvatore Brugaletta Cristina Ibañez Laura Sanchis Marta Sitges Josep Rodés-Cabau Manel Sabaté Xavier Freixa Low Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion
description	The optimal antithrombotic strategy following left atrial appendage occlusion (LAAO) is not yet clearly established. Low-dose non-vitamin K antagonist oral anticoagulants (NOAC) might represent a valid alternative, but data regarding their usage is scarce. The aim of this study was to examine the efficacy and safety of low-dose NOAC compared to single (SAPT) or dual antiplatelet therapies (DAPT) after LAAO. We included consecutive patients with non-valvular atrial fibrillation who underwent LAAO and received low-dose apixaban, SAPT, or DAPT at discharge. The primary objective of this study included an efficacy endpoint (thromboembolic events and device related thrombosis (DRT)) and a safety endpoint (incidence of major bleeding) within the first three months after LAAO. A total of 139 patients were included. This group involved SAPT in 26 (18%), DAPT in 73 (53%), and apixaban in 40 (29%) patients. Follow-up at three-months showed no significant differences in the primary efficacy endpoint (2 (8%) SAPT, 3 (4%) DAPT and 0 (0%) apixaban; <i>p</i> value = 0.25). In contrast, the primary safety endpoint occurred more frequently in DAPT patients (7 (10%) DAPT, 0 (0%), SAPT and 0 with apixaban; <i>p</i> value = 0.03). Combining both efficacy and safety outcomes, low dose apixaban had a lower rate of events (2 (8%) with SAPT, 9 (12%) with DAPT and 0 (0%) with apixaban; <i>p</i> = 0.046). Low-dose apixaban after LAAO may be a valid alternative to DAPT and SAPT as depicted by the reduction in the occurrence of major bleedings and combined DRT/major bleedings respectively. Randomized data will be necessary to validate this strategy.
format	article
author	Pedro Luis Cepas-Guillen Eduardo Flores-Umanzor Ander Regueiro Salvatore Brugaletta Cristina Ibañez Laura Sanchis Marta Sitges Josep Rodés-Cabau Manel Sabaté Xavier Freixa
author_facet	Pedro Luis Cepas-Guillen Eduardo Flores-Umanzor Ander Regueiro Salvatore Brugaletta Cristina Ibañez Laura Sanchis Marta Sitges Josep Rodés-Cabau Manel Sabaté Xavier Freixa
author_sort	Pedro Luis Cepas-Guillen
title	Low Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion
title_short	Low Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion
title_full	Low Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion
title_fullStr	Low Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion
title_full_unstemmed	Low Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion
title_sort	low dose of direct oral anticoagulants after left atrial appendage occlusion
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/5dfc3a33d4c74b4a9dab82beb028805c
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Low Dose of Direct Oral Anticoagulants after Left Atrial Appendage Occlusion

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