Abstract
Purpose
Data regarding post-procedural antithrombotic therapy following percutaneous left atrial appendage (LAA) in real-world populations using various occluder systems is limited. In the present analysis, anticoagulation (AC) was compared against antiplatelet therapy (APT) using data from the real-world multi-center LAARGE study.
Methods
Patients following LAA closure enrolled in the LAARGE study were assigned to two groups depending on initial post-implantation antithrombotic regime consisting of either AC or APT. Selection of antithrombotic medication was at the discretion of the treating center and/or physician.
Results
From July 2014 until January 2016, a total of 627 patients at 38 centers were included. A total of 75 patients (12%) received AC and 552 patients (88%) received APT, respectively. No significant differences were found between the groups regarding the composite of death, stroke and systemic embolism 1 year after LAA closure (Kaplan–Meier estimated rate 9.4% for AC vs. 12.8% for APT; p log rank = 0.45). With respect to bleeding events also, no differences were observed 1 year after the procedure (major bleeding 4.0% vs. 2.0%, p = 0.23; moderate bleeding 4.0% vs. 4.9%, p = 1.00; any bleeding 8.0% vs. 6.9%, p = 0.73).
Conclusions
Postprocedural antithrombotic treatment with AC and APT showed comparable results regarding the composite of death, stroke, and systemic embolism as well as regarding bleeding complications after LAA closure in a real-world all-comers population.
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Abbreviations
- AC:
-
Anticoagulation
- ACP:
-
Amplatzer Cardiac Plug
- AF:
-
Atrial fibrillation
- APT:
-
Antiplatelet therapy
- DAPT:
-
Dual antiplatelet therapy
- DOAC:
-
Direct oral anticoagulants
- LAA:
-
Left atrial appendage
- SAPT:
-
Single antiplatelet therapy
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Funding
The LAARGE registry was funded by the Stiftung Institut für Herzinfarktforschung (IHF; Ludwigshafen am Rhein, Germany). The present work was supported by an unrestricted grant from Boston Scientific (Marlborough, MA, USA).
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1) Jakob Ledwoch and Harald Mudra were involved in conception and design. Jakob Ledwoch, Stephan Staubach, Ibrahim Akin, Hüseyin Ince, Uwe Zeymer, Sven Pleger, Horst Sievert, Matthias Hochadel, Jochen Senges, Thorsten Lewalter and Johannes Brachmann were involved in analysis and interpretation of data; 2) Jakob Ledwoch drafted the manuscript. Stephan Staubach, Ibrahim Akin, Hüseyin Ince, Uwe Zeymer, Sven Pleger, Horst Sievert, Matthias Hochadel, Jochen Senges, Thorsten Lewalter, Johannes Brachmann and Harald Mudra revised it critically for important intellectual content; 3) final approval of the manuscript submitted was made by all authors.
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Conflict of interest
Jakob Ledwoch: none.
Stephan Staubach: none.
Ibrahim Akin: none.
Hüseyin Ince: none.
Uwe Zeymer: none.
Sven Pleger: none.
Horst Sievert: Study honorary, travel expenses, consulting fees from Access Closure, AGA, Angiomed, Ardian, Arstasis, Atritech, Atrium, Avinger, Bard, Boston Scientific, Bridgepoint, CardioKinetix, CardioMEMS, Coherex, Contego, CSI, EndoCross, EndoTex, Epitek, Evalve, ev3, FlowCardia, Gore, Guidant, Lumen Biomedical, HLT, Kensey Nash, Kyoto Medical, Lifetech, Lutonix, Medinol, Medtronic, NDC, NMT, OAS, Occlutech, Osprey, Ovalis, Pathway, PendraCare, Percardia, pfm Medical, Recor, Rox Medical, Sadra, Sorin, Spectranetics, SquareOne, Trireme, Trivascular, Viacor, Velocimed, Veryan.
Stock options from Cardiokinetix, Access Closure, Velocimed, CoAptus, Lumen Biomedical, Coherex.
Jochen Senges, Matthias Hochadel: Stiftung IHF received an unrestricted grant from Boston Scientific (Marlborough,MA, USA) for performing statistical analyses.
Thorsten Lewalter: Speaker honorary from St. Jude Medical/Abbott Vascular and Boston Scientific.
Johannes Brachmann: none.
Harald Mudra: none.
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Ledwoch, J., Staubach, S., Akin, I. et al. Anticoagulation versus antiplatelet therapy after percutaneous left atrial appendage closure—subanalysis from the multicenter LAARGE registry. J Interv Card Electrophysiol 64, 489–496 (2022). https://doi.org/10.1007/s10840-021-01080-1
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DOI: https://doi.org/10.1007/s10840-021-01080-1