Comparison of clinical outcomes between multiple antithrombotic therapy versus left atrial appendage occlusion with dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation
Complex antithrombotic regimens are recommended for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation but carry high bleeding risk. We aimed to evaluate whether left atrial appendage occlusion (LAAO) with dual antiplatelet therapy (DAPT) improve clinical outcome...
Gespeichert in:
| Veröffentlicht in: | PloS one 2021-01, Vol.16 (1), p.e0244723 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | 1 |
| container_start_page | e0244723 |
| container_title | PloS one |
| container_volume | 16 |
| creator | Kook, Hyungdon Kim, Hee-Dong Shim, Jaemin Kim, Young-Hoon Kim, Jung-Sun Pak, Hui-Nam Lee, Hyun-Jong Choi, Rak-Kyeong Kang, Woong-Chol Shin, Eun-Seok Park, Jai-Wun Yu, Cheol Woong Lim, Do-Sun |
| description | Complex antithrombotic regimens are recommended for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation but carry high bleeding risk.
We aimed to evaluate whether left atrial appendage occlusion (LAAO) with dual antiplatelet therapy (DAPT) improve clinical outcomes when compared with multiple antithrombotic therapy (MAT) in patients with AF undergoing DES implantation.
Among 475 AF patients who underwent DES, 41 patients treated by LAAO with DAPT and 434 patients on MAT were compared. MAT was defined as any combination of warfarin-based antithrombotic therapy. Among the MAT group, 34.8% were on triple antithrombotic therapy. The primary endpoint was a net adverse clinical event (NACE), a composite of cerebrovascular accident (CVA) and major bleeding. Secondary endpoints were CVA, major bleeding, major adverse cardiac and cerebral event (MACCE), MI, cardiovascular death, and all-cause death. Additional analysis between the new oral anticoagulant (NOAC)-based antithrombotic therapy group (n = 45) and the LAAO group was performed for the same endpoints. To adjust the confounding factors, inverse probability of treatment weighting (IPTW) was applied during the endpoint analysis.
The LAAO group showed higher incidences of diabetes mellitus, prior CVA, higher CHA2DS2-VASc score (4.56±1.55 vs. 2.96±1.60; P |
| doi_str_mv | 10.1371/journal.pone.0244723 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_2476219580</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A650815101</galeid><doaj_id>oai_doaj_org_article_887dc23ff7044ec69a6f373b5affe887</doaj_id><sourcerecordid>A650815101</sourcerecordid><originalsourceid>FETCH-LOGICAL-c692t-f3c1f277cd46398c1adc1a1e5d12c379cc5836741f16153042a106c6e47ab63f3</originalsourceid><addsrcrecordid>eNqNk9tq3DAQhk1padK0b1BaQaG0F7u1LFvy3hRC6GEhEOjpVmjlkVdBlhwdkuZh-y6Vs07IllwUYyxrvvlHM5opipe4XGLC8Idzl7wVZjk6C8uyqmtWkUfFIV6RakGrkjy-tz4onoVwXpYNaSl9WhwQUmPcYnpY_Dlxwyi8Ds4ip5A02mopDHIpSjdAQBuIVwAWDclEPRpAwkYdt94NGxe1RHELXozX6BJ8SAEZUBGJ6HXWEOMIthM9ICelSUHnGFfZF3VpstpJT0QwEO9UtEWjiBpsDDt0llJ647XJ9KSRbAe-d9r2qPOpX4BJcfoJMfshPWRVG2_Q58UTJUyAF_P3qPj5-dOPk6-L07Mv65Pj04WkqyouFJFYVYzJrqZk1UosuvxiaDpcScJWUjYtoazGClPckLKuBC6ppFAzsaFEkaPi9U53NC7w-WYCr2pGK7xq2jIT6x3ROXHOR68H4a-5E5rfbDjfc-FzPQ3wtmWdrIhSrKxryCcUVBFGNo1QCrIxa32co6XNAJ3MWXth9kT3LVZvee8uOWOrkrR1Fng3C3h3kSBEPuggIdfXgku7czc09xPJ6Jt_0Iezm6le5AS0VS7HlZMoP6ZN2eIGlzhTyweo_HQwaJnbWOm8v-fwfs8hMxF-x16kEPj6-7f_Z89-7bNv77FbECZug5u6yNmwD9Y7UHoXggd1V2Rc8mkKb6vBpynk8xRmt1f3L-jO6XbsyF-oczSI</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2476219580</pqid></control><display><type>article</type><title>Comparison of clinical outcomes between multiple antithrombotic therapy versus left atrial appendage occlusion with dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Public Library of Science (PLoS) Journals Open Access</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><creator>Kook, Hyungdon ; Kim, Hee-Dong ; Shim, Jaemin ; Kim, Young-Hoon ; Kim, Jung-Sun ; Pak, Hui-Nam ; Lee, Hyun-Jong ; Choi, Rak-Kyeong ; Kang, Woong-Chol ; Shin, Eun-Seok ; Park, Jai-Wun ; Yu, Cheol Woong ; Lim, Do-Sun</creator><contributor>Finn, Aloke</contributor><creatorcontrib>Kook, Hyungdon ; Kim, Hee-Dong ; Shim, Jaemin ; Kim, Young-Hoon ; Kim, Jung-Sun ; Pak, Hui-Nam ; Lee, Hyun-Jong ; Choi, Rak-Kyeong ; Kang, Woong-Chol ; Shin, Eun-Seok ; Park, Jai-Wun ; Yu, Cheol Woong ; Lim, Do-Sun ; Finn, Aloke</creatorcontrib><description>Complex antithrombotic regimens are recommended for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation but carry high bleeding risk.
We aimed to evaluate whether left atrial appendage occlusion (LAAO) with dual antiplatelet therapy (DAPT) improve clinical outcomes when compared with multiple antithrombotic therapy (MAT) in patients with AF undergoing DES implantation.
Among 475 AF patients who underwent DES, 41 patients treated by LAAO with DAPT and 434 patients on MAT were compared. MAT was defined as any combination of warfarin-based antithrombotic therapy. Among the MAT group, 34.8% were on triple antithrombotic therapy. The primary endpoint was a net adverse clinical event (NACE), a composite of cerebrovascular accident (CVA) and major bleeding. Secondary endpoints were CVA, major bleeding, major adverse cardiac and cerebral event (MACCE), MI, cardiovascular death, and all-cause death. Additional analysis between the new oral anticoagulant (NOAC)-based antithrombotic therapy group (n = 45) and the LAAO group was performed for the same endpoints. To adjust the confounding factors, inverse probability of treatment weighting (IPTW) was applied during the endpoint analysis.
The LAAO group showed higher incidences of diabetes mellitus, prior CVA, higher CHA2DS2-VASc score (4.56±1.55 vs. 2.96±1.60; P<0.0001), and higher HAS-BLED score (3.24±1.20 vs. 2.13±0.75; P<0.0001). NACE occurred less frequently in the LAAO group than the MAT group at 24 months (9.4% vs. 15.3%; hazard ratio 0.274; 95% confidence interval 0.136 - 0.553; P = 0.0003), mainly driven by the reduction in major bleeding (2.4% vs. 9.3%; hazard ratio 0.119; 95% confidence interval 0.032 - 0.438; P = 0.001). The LAAO group with greater thrombotic and hemorrhagic risks showed comparable primary/secondary outcomes with the NOAC-based anti-thrombotic therapy group.
Among patients with AF who underwent DES implantation, the LAAO group had better net clinical outcomes for preventing CVA and major bleeding than the MAT group. Further large-scale trials including comparisons with NOACs are warranted.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0244723</identifier><identifier>PMID: 33411816</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Aged, 80 and over ; Aggregation ; Anticoagulants ; Antiplatelet therapy ; Atrial fibrillation ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - surgery ; Biology and Life Sciences ; Bleeding ; Blood platelets ; Blood vessels ; Cardiac arrhythmia ; Cardiovascular disease ; Care and treatment ; Cerebral blood flow ; Clinical outcomes ; Clinical trials ; Comparative analysis ; Confidence intervals ; Coronary Artery Disease - drug therapy ; Coronary Artery Disease - surgery ; Coronary vessels ; Diabetes ; Diabetes mellitus ; Drug delivery ; Drug-eluting stents ; Drug-Eluting Stents - adverse effects ; Dual Anti-Platelet Therapy ; Engineering and Technology ; Female ; Fibrillation ; Fibrinolytic Agents - therapeutic use ; Health hazards ; Health risks ; Heart failure ; Hemorrhage ; Hemorrhage - etiology ; Hospitals ; Humans ; Implantation ; Implants ; Ischemia ; Male ; Medicine and Health Sciences ; Occlusion ; Patient outcomes ; Patients ; Percutaneous Coronary Intervention - adverse effects ; Platelet Aggregation Inhibitors - therapeutic use ; Statistical analysis ; Stents ; Stroke ; Surgery ; Surgical implants ; Therapy ; Thrombolytic drugs ; Treatment Outcome ; Warfarin</subject><ispartof>PloS one, 2021-01, Vol.16 (1), p.e0244723</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Kook et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Kook et al 2021 Kook et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-f3c1f277cd46398c1adc1a1e5d12c379cc5836741f16153042a106c6e47ab63f3</citedby><cites>FETCH-LOGICAL-c692t-f3c1f277cd46398c1adc1a1e5d12c379cc5836741f16153042a106c6e47ab63f3</cites><orcidid>0000-0003-1440-0462 ; 0000-0002-3256-3620</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790384/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790384/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33411816$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Finn, Aloke</contributor><creatorcontrib>Kook, Hyungdon</creatorcontrib><creatorcontrib>Kim, Hee-Dong</creatorcontrib><creatorcontrib>Shim, Jaemin</creatorcontrib><creatorcontrib>Kim, Young-Hoon</creatorcontrib><creatorcontrib>Kim, Jung-Sun</creatorcontrib><creatorcontrib>Pak, Hui-Nam</creatorcontrib><creatorcontrib>Lee, Hyun-Jong</creatorcontrib><creatorcontrib>Choi, Rak-Kyeong</creatorcontrib><creatorcontrib>Kang, Woong-Chol</creatorcontrib><creatorcontrib>Shin, Eun-Seok</creatorcontrib><creatorcontrib>Park, Jai-Wun</creatorcontrib><creatorcontrib>Yu, Cheol Woong</creatorcontrib><creatorcontrib>Lim, Do-Sun</creatorcontrib><title>Comparison of clinical outcomes between multiple antithrombotic therapy versus left atrial appendage occlusion with dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Complex antithrombotic regimens are recommended for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation but carry high bleeding risk.
We aimed to evaluate whether left atrial appendage occlusion (LAAO) with dual antiplatelet therapy (DAPT) improve clinical outcomes when compared with multiple antithrombotic therapy (MAT) in patients with AF undergoing DES implantation.
Among 475 AF patients who underwent DES, 41 patients treated by LAAO with DAPT and 434 patients on MAT were compared. MAT was defined as any combination of warfarin-based antithrombotic therapy. Among the MAT group, 34.8% were on triple antithrombotic therapy. The primary endpoint was a net adverse clinical event (NACE), a composite of cerebrovascular accident (CVA) and major bleeding. Secondary endpoints were CVA, major bleeding, major adverse cardiac and cerebral event (MACCE), MI, cardiovascular death, and all-cause death. Additional analysis between the new oral anticoagulant (NOAC)-based antithrombotic therapy group (n = 45) and the LAAO group was performed for the same endpoints. To adjust the confounding factors, inverse probability of treatment weighting (IPTW) was applied during the endpoint analysis.
The LAAO group showed higher incidences of diabetes mellitus, prior CVA, higher CHA2DS2-VASc score (4.56±1.55 vs. 2.96±1.60; P<0.0001), and higher HAS-BLED score (3.24±1.20 vs. 2.13±0.75; P<0.0001). NACE occurred less frequently in the LAAO group than the MAT group at 24 months (9.4% vs. 15.3%; hazard ratio 0.274; 95% confidence interval 0.136 - 0.553; P = 0.0003), mainly driven by the reduction in major bleeding (2.4% vs. 9.3%; hazard ratio 0.119; 95% confidence interval 0.032 - 0.438; P = 0.001). The LAAO group with greater thrombotic and hemorrhagic risks showed comparable primary/secondary outcomes with the NOAC-based anti-thrombotic therapy group.
Among patients with AF who underwent DES implantation, the LAAO group had better net clinical outcomes for preventing CVA and major bleeding than the MAT group. Further large-scale trials including comparisons with NOACs are warranted.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aggregation</subject><subject>Anticoagulants</subject><subject>Antiplatelet therapy</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - surgery</subject><subject>Biology and Life Sciences</subject><subject>Bleeding</subject><subject>Blood platelets</subject><subject>Blood vessels</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Care and treatment</subject><subject>Cerebral blood flow</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Comparative analysis</subject><subject>Confidence intervals</subject><subject>Coronary Artery Disease - drug therapy</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary vessels</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Drug delivery</subject><subject>Drug-eluting stents</subject><subject>Drug-Eluting Stents - adverse effects</subject><subject>Dual Anti-Platelet Therapy</subject><subject>Engineering and Technology</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Health hazards</subject><subject>Health risks</subject><subject>Heart failure</subject><subject>Hemorrhage</subject><subject>Hemorrhage - etiology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Implantation</subject><subject>Implants</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Occlusion</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Statistical analysis</subject><subject>Stents</subject><subject>Stroke</subject><subject>Surgery</subject><subject>Surgical implants</subject><subject>Therapy</subject><subject>Thrombolytic drugs</subject><subject>Treatment Outcome</subject><subject>Warfarin</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9tq3DAQhk1padK0b1BaQaG0F7u1LFvy3hRC6GEhEOjpVmjlkVdBlhwdkuZh-y6Vs07IllwUYyxrvvlHM5opipe4XGLC8Idzl7wVZjk6C8uyqmtWkUfFIV6RakGrkjy-tz4onoVwXpYNaSl9WhwQUmPcYnpY_Dlxwyi8Ds4ip5A02mopDHIpSjdAQBuIVwAWDclEPRpAwkYdt94NGxe1RHELXozX6BJ8SAEZUBGJ6HXWEOMIthM9ICelSUHnGFfZF3VpstpJT0QwEO9UtEWjiBpsDDt0llJ647XJ9KSRbAe-d9r2qPOpX4BJcfoJMfshPWRVG2_Q58UTJUyAF_P3qPj5-dOPk6-L07Mv65Pj04WkqyouFJFYVYzJrqZk1UosuvxiaDpcScJWUjYtoazGClPckLKuBC6ppFAzsaFEkaPi9U53NC7w-WYCr2pGK7xq2jIT6x3ROXHOR68H4a-5E5rfbDjfc-FzPQ3wtmWdrIhSrKxryCcUVBFGNo1QCrIxa32co6XNAJ3MWXth9kT3LVZvee8uOWOrkrR1Fng3C3h3kSBEPuggIdfXgku7czc09xPJ6Jt_0Iezm6le5AS0VS7HlZMoP6ZN2eIGlzhTyweo_HQwaJnbWOm8v-fwfs8hMxF-x16kEPj6-7f_Z89-7bNv77FbECZug5u6yNmwD9Y7UHoXggd1V2Rc8mkKb6vBpynk8xRmt1f3L-jO6XbsyF-oczSI</recordid><startdate>20210107</startdate><enddate>20210107</enddate><creator>Kook, Hyungdon</creator><creator>Kim, Hee-Dong</creator><creator>Shim, Jaemin</creator><creator>Kim, Young-Hoon</creator><creator>Kim, Jung-Sun</creator><creator>Pak, Hui-Nam</creator><creator>Lee, Hyun-Jong</creator><creator>Choi, Rak-Kyeong</creator><creator>Kang, Woong-Chol</creator><creator>Shin, Eun-Seok</creator><creator>Park, Jai-Wun</creator><creator>Yu, Cheol Woong</creator><creator>Lim, Do-Sun</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-1440-0462</orcidid><orcidid>https://orcid.org/0000-0002-3256-3620</orcidid></search><sort><creationdate>20210107</creationdate><title>Comparison of clinical outcomes between multiple antithrombotic therapy versus left atrial appendage occlusion with dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation</title><author>Kook, Hyungdon ; Kim, Hee-Dong ; Shim, Jaemin ; Kim, Young-Hoon ; Kim, Jung-Sun ; Pak, Hui-Nam ; Lee, Hyun-Jong ; Choi, Rak-Kyeong ; Kang, Woong-Chol ; Shin, Eun-Seok ; Park, Jai-Wun ; Yu, Cheol Woong ; Lim, Do-Sun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-f3c1f277cd46398c1adc1a1e5d12c379cc5836741f16153042a106c6e47ab63f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aggregation</topic><topic>Anticoagulants</topic><topic>Antiplatelet therapy</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - surgery</topic><topic>Biology and Life Sciences</topic><topic>Bleeding</topic><topic>Blood platelets</topic><topic>Blood vessels</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular disease</topic><topic>Care and treatment</topic><topic>Cerebral blood flow</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Comparative analysis</topic><topic>Confidence intervals</topic><topic>Coronary Artery Disease - drug therapy</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary vessels</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Drug delivery</topic><topic>Drug-eluting stents</topic><topic>Drug-Eluting Stents - adverse effects</topic><topic>Dual Anti-Platelet Therapy</topic><topic>Engineering and Technology</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Health hazards</topic><topic>Health risks</topic><topic>Heart failure</topic><topic>Hemorrhage</topic><topic>Hemorrhage - etiology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Implantation</topic><topic>Implants</topic><topic>Ischemia</topic><topic>Male</topic><topic>Medicine and Health Sciences</topic><topic>Occlusion</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Statistical analysis</topic><topic>Stents</topic><topic>Stroke</topic><topic>Surgery</topic><topic>Surgical implants</topic><topic>Therapy</topic><topic>Thrombolytic drugs</topic><topic>Treatment Outcome</topic><topic>Warfarin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kook, Hyungdon</creatorcontrib><creatorcontrib>Kim, Hee-Dong</creatorcontrib><creatorcontrib>Shim, Jaemin</creatorcontrib><creatorcontrib>Kim, Young-Hoon</creatorcontrib><creatorcontrib>Kim, Jung-Sun</creatorcontrib><creatorcontrib>Pak, Hui-Nam</creatorcontrib><creatorcontrib>Lee, Hyun-Jong</creatorcontrib><creatorcontrib>Choi, Rak-Kyeong</creatorcontrib><creatorcontrib>Kang, Woong-Chol</creatorcontrib><creatorcontrib>Shin, Eun-Seok</creatorcontrib><creatorcontrib>Park, Jai-Wun</creatorcontrib><creatorcontrib>Yu, Cheol Woong</creatorcontrib><creatorcontrib>Lim, Do-Sun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kook, Hyungdon</au><au>Kim, Hee-Dong</au><au>Shim, Jaemin</au><au>Kim, Young-Hoon</au><au>Kim, Jung-Sun</au><au>Pak, Hui-Nam</au><au>Lee, Hyun-Jong</au><au>Choi, Rak-Kyeong</au><au>Kang, Woong-Chol</au><au>Shin, Eun-Seok</au><au>Park, Jai-Wun</au><au>Yu, Cheol Woong</au><au>Lim, Do-Sun</au><au>Finn, Aloke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of clinical outcomes between multiple antithrombotic therapy versus left atrial appendage occlusion with dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-01-07</date><risdate>2021</risdate><volume>16</volume><issue>1</issue><spage>e0244723</spage><pages>e0244723-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Complex antithrombotic regimens are recommended for patients with atrial fibrillation (AF) undergoing drug-eluting stent (DES) implantation but carry high bleeding risk.
We aimed to evaluate whether left atrial appendage occlusion (LAAO) with dual antiplatelet therapy (DAPT) improve clinical outcomes when compared with multiple antithrombotic therapy (MAT) in patients with AF undergoing DES implantation.
Among 475 AF patients who underwent DES, 41 patients treated by LAAO with DAPT and 434 patients on MAT were compared. MAT was defined as any combination of warfarin-based antithrombotic therapy. Among the MAT group, 34.8% were on triple antithrombotic therapy. The primary endpoint was a net adverse clinical event (NACE), a composite of cerebrovascular accident (CVA) and major bleeding. Secondary endpoints were CVA, major bleeding, major adverse cardiac and cerebral event (MACCE), MI, cardiovascular death, and all-cause death. Additional analysis between the new oral anticoagulant (NOAC)-based antithrombotic therapy group (n = 45) and the LAAO group was performed for the same endpoints. To adjust the confounding factors, inverse probability of treatment weighting (IPTW) was applied during the endpoint analysis.
The LAAO group showed higher incidences of diabetes mellitus, prior CVA, higher CHA2DS2-VASc score (4.56±1.55 vs. 2.96±1.60; P<0.0001), and higher HAS-BLED score (3.24±1.20 vs. 2.13±0.75; P<0.0001). NACE occurred less frequently in the LAAO group than the MAT group at 24 months (9.4% vs. 15.3%; hazard ratio 0.274; 95% confidence interval 0.136 - 0.553; P = 0.0003), mainly driven by the reduction in major bleeding (2.4% vs. 9.3%; hazard ratio 0.119; 95% confidence interval 0.032 - 0.438; P = 0.001). The LAAO group with greater thrombotic and hemorrhagic risks showed comparable primary/secondary outcomes with the NOAC-based anti-thrombotic therapy group.
Among patients with AF who underwent DES implantation, the LAAO group had better net clinical outcomes for preventing CVA and major bleeding than the MAT group. Further large-scale trials including comparisons with NOACs are warranted.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33411816</pmid><doi>10.1371/journal.pone.0244723</doi><tpages>e0244723</tpages><orcidid>https://orcid.org/0000-0003-1440-0462</orcidid><orcidid>https://orcid.org/0000-0002-3256-3620</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2021-01, Vol.16 (1), p.e0244723 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2476219580 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged Aged, 80 and over Aggregation Anticoagulants Antiplatelet therapy Atrial fibrillation Atrial Fibrillation - drug therapy Atrial Fibrillation - surgery Biology and Life Sciences Bleeding Blood platelets Blood vessels Cardiac arrhythmia Cardiovascular disease Care and treatment Cerebral blood flow Clinical outcomes Clinical trials Comparative analysis Confidence intervals Coronary Artery Disease - drug therapy Coronary Artery Disease - surgery Coronary vessels Diabetes Diabetes mellitus Drug delivery Drug-eluting stents Drug-Eluting Stents - adverse effects Dual Anti-Platelet Therapy Engineering and Technology Female Fibrillation Fibrinolytic Agents - therapeutic use Health hazards Health risks Heart failure Hemorrhage Hemorrhage - etiology Hospitals Humans Implantation Implants Ischemia Male Medicine and Health Sciences Occlusion Patient outcomes Patients Percutaneous Coronary Intervention - adverse effects Platelet Aggregation Inhibitors - therapeutic use Statistical analysis Stents Stroke Surgery Surgical implants Therapy Thrombolytic drugs Treatment Outcome Warfarin |
| title | Comparison of clinical outcomes between multiple antithrombotic therapy versus left atrial appendage occlusion with dual antiplatelet therapy in patients with atrial fibrillation undergoing drug-eluting stent implantation |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T09%3A22%3A53IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Comparison%20of%20clinical%20outcomes%20between%20multiple%20antithrombotic%20therapy%20versus%20left%20atrial%20appendage%20occlusion%20with%20dual%20antiplatelet%20therapy%20in%20patients%20with%20atrial%20fibrillation%20undergoing%20drug-eluting%20stent%20implantation&rft.jtitle=PloS%20one&rft.au=Kook,%20Hyungdon&rft.date=2021-01-07&rft.volume=16&rft.issue=1&rft.spage=e0244723&rft.pages=e0244723-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0244723&rft_dat=%3Cgale_plos_%3EA650815101%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2476219580&rft_id=info:pmid/33411816&rft_galeid=A650815101&rft_doaj_id=oai_doaj_org_article_887dc23ff7044ec69a6f373b5affe887&rfr_iscdi=true |