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Anticoagulation versus antiplatelet therapy after percutaneous left atrial appendage closure—subanalysis from the multicenter LAARGE registry

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

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

References

  1. Brachmann J, Lewalter T, Akin I, Sievert H, Geist V, Zeymer U, Erkapic D, Mudra H, Pleger S, Hochadel M, Senges J. Interventional occlusion of left atrial appendage in patients with atrial fibrillation. Acute and long-term outcome of occluder implantation in the LAARGE Registry. J Interv Card Electrophysiol. 2020;58:273–80.

  2. Dukkipati SR, Kar S, Holmes DR, Doshi SK, Swarup V, Gibson DN, Maini B, Gordon NT, Main ML, Reddy VY. Device-Related Thrombus After Left Atrial Appendage Closure. Circulation. 2018;138:874–85.

    Article  Google Scholar 

  3. Holmes DR Jr, Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK, Huber K, Reddy VY. Prospective Randomized Evaluation of the Watchman Left Atrial Appendage Closure Device in Patients With Atrial Fibrillation Versus Long-Term Warfarin Therapy: The PREVAIL Trial. J Am Coll Cardiol. 2014;64:1–12.

    Article  Google Scholar 

  4. Reddy VY, Sievert H, Halperin J, Doshi SK, Buchbinder M, Neuzil P, Huber K, Whisenant B, Kar S, Swarup V, Gordon N, Holmes D, Committee PAS, Investigators. . Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA. 2014;312:1988–98.

    Article  Google Scholar 

  5. Boersma LV, Schmidt B, Betts TR, Sievert H, Tamburino C, Teiger E, Pokushalov E, Kische S, Schmitz T, Stein KM, Bergmann MW, investigators E. . Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry. Eur Heart J. 2016;37:2465–74.

    Article  Google Scholar 

  6. Sondergaard L, Wong YH, Reddy VY, Boersma LVA, Bergmann MW, Doshi S, Kar S, Sievert H, Wehrenberg S, Stein K, Holmes DR Jr. Propensity-Matched Comparison of Oral Anticoagulation Versus Antiplatelet Therapy After Left Atrial Appendage Closure With WATCHMAN. JACC Cardiovasc Interv. 2019;12:1055–63.

    Article  Google Scholar 

  7. Boersma LV, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Protopopov AV, Betts T, Mazzone P, Foley D, Grygier M, Sievert H, De Potter T, Vireca E, Stein K, Bergmann MW, following i institutions participated in the Es. Evaluating Real World Clinical Outcomes in Atrial Fibrillation Patients Receiving the WATCHMAN Left Atrial Appendage Closure Technology. Circ Arrhythm Electrophysiol. 2019;12:e006841.

    Article  Google Scholar 

  8. Landmesser U, Tondo C, Camm J, Diener HC, Paul V, Schmidt B, Settergren M, Teiger E, Nielsen-Kudsk JE, Hildick-Smith D. Left atrial appendage occlusion with the AMPLATZER Amulet device: one-year follow-up from the prospective global Amulet observational registry. EuroIntervention. 2018;14:e590–7.

    Article  Google Scholar 

  9. Bergmann MW, Betts TR, Sievert H, Schmidt B, Pokushalov E, Kische S, Schmitz T, Meincke F, Stein KM, Boersma LVA, Ince H. Safety and efficacy of early anticoagulation drug regimens after WATCHMAN left atrial appendage closure: three-month data from the EWOLUTION prospective, multicentre, monitored international WATCHMAN LAA closure registry. EuroIntervention. 2017;13:877–84.

    Article  Google Scholar 

  10. Tzikas A, Shakir S, Gafoor S, Omran H, Berti S, Santoro G, Kefer J, Landmesser U, Nielsen-Kudsk JE, Cruz-Gonzalez I, Sievert H, Tichelbacker T, Kanagaratnam P, Nietlispach F, Aminian A, Kasch F, Freixa X, Danna P, Rezzaghi M, Vermeersch P, Stock F, Stolcova M, Costa M, Ibrahim R, Schillinger W, Meier B, Park JW. Left atrial appendage occlusion for stroke prevention in atrial fibrillation: multicentre experience with the AMPLATZER Cardiac Plug. EuroIntervention. 2016;11:1170–9.

    Article  Google Scholar 

  11. Liu XX, Kleinecke C, Busch S, Allakkis W, Mohrez Y, Cheikh-Ibrahim M, Mahnkopf C, Brachmann J, Schnupp S, Gloekler S, Yu J, Ma C. Propensity-matched comparison of antiplatelet vs. anticoagulant after left atrial appendage closure with the Watchman. Pacing Clin Electrophysiol. 2020;43:1242–51.

  12. Ledwoch J, Sievert K, Boersma LVA, Bergmann MW, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Protopopov AV, Betts TR, Mazzone P, Foley D, Grygier M, De Potter T, Sievert H, Investigators E. Initial and long-term antithrombotic therapy after left atrial appendage closure with the WATCHMAN. Europace. 2020;22:1036–43.

    Article  Google Scholar 

  13. Tilz RR, Potpara T, Chen J, Dobreanu D, Larsen TB, Haugaa KH, Dagres N. Left atrial appendage occluder implantation in Europe: indications and anticoagulation post-implantation. Results of the European Heart Rhythm Association Survey. Europace. 2017;19:1737–42.

    Article  Google Scholar 

  14. Fauchier L, Cinaud A, Brigadeau F, Lepillier A, Pierre B, Abbey S, Fatemi M, Franceschi F, Guedeney P, Jacon P, Paziaud O, Venier S, Deharo JC, Gras D, Klug D, Mansourati J, Montalescot G, Piot O, Defaye P. Device-Related Thrombosis After Percutaneous Left Atrial Appendage Occlusion for Atrial Fibrillation. J Am Coll Cardiol. 2018;71:1528–36.

    Article  Google Scholar 

  15. Asmarats L, O’Hara G, Champagne J, Paradis JM, Bernier M, O’Connor K, Beaudoin J, Junquera L, Del Val D, Muntane-Carol G, Cote M, Rodes-Cabau J. Short-Term Oral Anticoagulation Versus Antiplatelet Therapy Following Transcatheter Left Atrial Appendage. Closure Circ Cardiovasc Interv. 2020;13:e009039.

    Article  CAS  Google Scholar 

  16. Duthoit G, Silvain J, Marijon E, Ducrocq G, Lepillier A, Frere C, Dimby SF, Popovic B, Lellouche N, Martin-Toutain I, Spaulding C, Brochet E, Attias D, Mansourati J, Lorgis L, Klug D, Zannad N, Hauguel-Moreau M, Braik N, Deltour S, Ceccaldi A, Wang H, Hammoudi N, Brugier D, Vicaut E, Juliard JM, Montalescot G. Reduced Rivaroxaban Dose Versus Dual Antiplatelet Therapy After Left Atrial Appendage Closure: ADRIFT a Randomized Pilot Study. Circ Cardiovasc Interv. 2020;13:e008481.

    Article  CAS  Google Scholar 

Download references

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).

Author information

Authors and Affiliations

  1. Klinik Für Kardiologie, Pneumologie Und Intern. Intensivmed., Klinikum Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, München, Germany

    Jakob Ledwoch, Stephan Staubach & Harald Mudra

  2. I. Medizinische Klinik, Universitätsmedizin, Mannheim, Germany

    Ibrahim Akin

  3. Universitätsmedizin Rostock, Rostock, Germany

    Hüseyin Ince

  4. I. Medizinische Klinik B, Klinikum Der Stadt Ludwigshafen, Ludwigshafen, Germany

    Uwe Zeymer

  5. Innere Medizin III, Universitätsklinikum, Heidelberg, Germany

    Sven Pleger

  6. CardioVascular Center CVC, Frankfurt, Germany

    Horst Sievert

  7. Stiftung Institut Für Herzinfarktforschung (IHF), Ludwigshafen, Germany

    Matthias Hochadel & Jochen Senges

  8. Peter Osypka Heart Center Munich, München, Germany

    Thorsten Lewalter

  9. Medizinische Klinik II, Klinikum Coburg, Coburg, Germany

    Johannes Brachmann

Authors
  1. Jakob Ledwoch
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  2. Stephan Staubach
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  7. Horst Sievert
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  10. Thorsten Lewalter
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Contributions

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.

Corresponding author

Correspondence to Jakob Ledwoch.

Ethics declarations

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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