Effectiveness and safety of short-term anticoagulant regimens after left atrial appendage occlusion: A systematic review and meta-analysis
Left atrial appendage occlusion (LAAO) provides an alternative for poor candidates of long-term oral anticoagulant (OAC) therapy; however, anticoagulant therapy after surgical procedures has limited use due to associated uncertainties. We aimed to evaluate the effectiveness and safety of the short-t...
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| Veröffentlicht in: | Thrombosis research 2024-01, Vol.233, p.88-98 |
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| creator | Zhou, Qiang Liu, Xiang Yang, Xian Huang, Xiao-Hui Wu, Yan-Zi Tao, Ying-Ying Wei, Meng |
| description | Left atrial appendage occlusion (LAAO) provides an alternative for poor candidates of long-term oral anticoagulant (OAC) therapy; however, anticoagulant therapy after surgical procedures has limited use due to associated uncertainties. We aimed to evaluate the effectiveness and safety of the short-term use of direct oral anticoagulant (DOAC) and warfarin after LAAO.
Electronic databases such as PubMed, Embase, Medline, and Cochrane Library databases were searched up to November 11, 2022. Our study compared DOAC therapy and warfarin in patients after LAAO. A meta-analysis was conducted with the Review Manager software (version 5.4).
The meta-analysis included 13 cohort studies with a total of 32,607 patients. Our findings indicated that the incidence of stroke/TIA/SE, peri-device leaks>5 mm, device-related thrombosis, and all-cause mortality were not significantly different between the two groups after LAAO (P > 0.05). The DOAC group had a significantly lower incidence of major bleeding (OR = 0.83, 95 % CI: 0.74-0.94, P = 0.003), any bleeding (OR = 0.34, 95 % CI: 0.23-0.51, P |
| doi_str_mv | 10.1016/j.thromres.2023.10.021 |
| format | Article |
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Electronic databases such as PubMed, Embase, Medline, and Cochrane Library databases were searched up to November 11, 2022. Our study compared DOAC therapy and warfarin in patients after LAAO. A meta-analysis was conducted with the Review Manager software (version 5.4).
The meta-analysis included 13 cohort studies with a total of 32,607 patients. Our findings indicated that the incidence of stroke/TIA/SE, peri-device leaks>5 mm, device-related thrombosis, and all-cause mortality were not significantly different between the two groups after LAAO (P > 0.05). The DOAC group had a significantly lower incidence of major bleeding (OR = 0.83, 95 % CI: 0.74-0.94, P = 0.003), any bleeding (OR = 0.34, 95 % CI: 0.23-0.51, P < 0.001), stroke/TIA/SE and major bleeding (OR = 0.57, 95 % CI: 0.34-0.95, P = 0.03), and any major adverse event (OR = 0.89, 95 % CI:0.82-0.97, P = 0.010) than the warfarin group. The subgroup analysis revealed that the rate of stroke/TIA/SE was similar in the two groups in terms of the different regions, follow-up time, study type, anticoagulant strategy, and bleeding risk. The incidence of major bleeding in the DOAC group was significantly lower than that in the warfarin group in North America, as well as at follow-up period ≤6 months, retrospective cohort, HAS-BLED average score ≥ 3. In addition, the risk of major bleeding was higher with the combination of OAC and single antiplatelet therapy (SAPT) than with OAC alone. Finally, in the North American region, retrospective cohort, and HAS-BLED average score ≥ 3, the incidence of any serious adverse event in the DOAC group was still significantly lower than that in the warfarin group.
Compared to warfarin, DOAC reduced the risk of major bleeding and any serious adverse event in patients after LAAO. This advantage was particularly notable in North America and high-risk populations for bleeding. In addition, the incidence of device-related thrombosis, peri-device leaks, stroke/TIA/SE and all-cause mortality were similar in both groups. The risk of major bleeding was lower in patients taking OAC alone compared with those taking OAC plus SAPT, without increasing the risk of thrombosis.</description><identifier>ISSN: 0049-3848</identifier><identifier>EISSN: 1879-2472</identifier><identifier>DOI: 10.1016/j.thromres.2023.10.021</identifier><identifier>PMID: 38035647</identifier><language>eng</language><publisher>United States</publisher><subject>Anticoagulants - adverse effects ; Atrial Appendage - surgery ; Atrial Fibrillation - complications ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - surgery ; Hemorrhage - chemically induced ; Humans ; Ischemic Attack, Transient ; Retrospective Studies ; Stroke - epidemiology ; Stroke - etiology ; Stroke - prevention & control ; Thrombosis - complications ; Treatment Outcome ; Warfarin - adverse effects</subject><ispartof>Thrombosis research, 2024-01, Vol.233, p.88-98</ispartof><rights>Copyright © 2023 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c258t-20a4118e72746ce1208541f1f451678e35c39ac1946aeabb811976bd98c5dda03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38035647$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhou, Qiang</creatorcontrib><creatorcontrib>Liu, Xiang</creatorcontrib><creatorcontrib>Yang, Xian</creatorcontrib><creatorcontrib>Huang, Xiao-Hui</creatorcontrib><creatorcontrib>Wu, Yan-Zi</creatorcontrib><creatorcontrib>Tao, Ying-Ying</creatorcontrib><creatorcontrib>Wei, Meng</creatorcontrib><title>Effectiveness and safety of short-term anticoagulant regimens after left atrial appendage occlusion: A systematic review and meta-analysis</title><title>Thrombosis research</title><addtitle>Thromb Res</addtitle><description>Left atrial appendage occlusion (LAAO) provides an alternative for poor candidates of long-term oral anticoagulant (OAC) therapy; however, anticoagulant therapy after surgical procedures has limited use due to associated uncertainties. We aimed to evaluate the effectiveness and safety of the short-term use of direct oral anticoagulant (DOAC) and warfarin after LAAO.
Electronic databases such as PubMed, Embase, Medline, and Cochrane Library databases were searched up to November 11, 2022. Our study compared DOAC therapy and warfarin in patients after LAAO. A meta-analysis was conducted with the Review Manager software (version 5.4).
The meta-analysis included 13 cohort studies with a total of 32,607 patients. Our findings indicated that the incidence of stroke/TIA/SE, peri-device leaks>5 mm, device-related thrombosis, and all-cause mortality were not significantly different between the two groups after LAAO (P > 0.05). The DOAC group had a significantly lower incidence of major bleeding (OR = 0.83, 95 % CI: 0.74-0.94, P = 0.003), any bleeding (OR = 0.34, 95 % CI: 0.23-0.51, P < 0.001), stroke/TIA/SE and major bleeding (OR = 0.57, 95 % CI: 0.34-0.95, P = 0.03), and any major adverse event (OR = 0.89, 95 % CI:0.82-0.97, P = 0.010) than the warfarin group. The subgroup analysis revealed that the rate of stroke/TIA/SE was similar in the two groups in terms of the different regions, follow-up time, study type, anticoagulant strategy, and bleeding risk. The incidence of major bleeding in the DOAC group was significantly lower than that in the warfarin group in North America, as well as at follow-up period ≤6 months, retrospective cohort, HAS-BLED average score ≥ 3. In addition, the risk of major bleeding was higher with the combination of OAC and single antiplatelet therapy (SAPT) than with OAC alone. Finally, in the North American region, retrospective cohort, and HAS-BLED average score ≥ 3, the incidence of any serious adverse event in the DOAC group was still significantly lower than that in the warfarin group.
Compared to warfarin, DOAC reduced the risk of major bleeding and any serious adverse event in patients after LAAO. This advantage was particularly notable in North America and high-risk populations for bleeding. In addition, the incidence of device-related thrombosis, peri-device leaks, stroke/TIA/SE and all-cause mortality were similar in both groups. The risk of major bleeding was lower in patients taking OAC alone compared with those taking OAC plus SAPT, without increasing the risk of thrombosis.</description><subject>Anticoagulants - adverse effects</subject><subject>Atrial Appendage - surgery</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - surgery</subject><subject>Hemorrhage - chemically induced</subject><subject>Humans</subject><subject>Ischemic Attack, Transient</subject><subject>Retrospective Studies</subject><subject>Stroke - epidemiology</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>Thrombosis - complications</subject><subject>Treatment Outcome</subject><subject>Warfarin - adverse effects</subject><issn>0049-3848</issn><issn>1879-2472</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9UcFu2zAMFYYNa5rtFwode3EmybIt9VYU7TagQC_d2WBkKlVgW5kod8gv9KunrO1OJB7fewT5GLuQYiOFbL_tN_kpxSkhbZRQdQE3QskPbCVNZyulO_WRrYTQtqqNNmfsnGgvhOykbT6zs9qIuml1t2Ivt96jy-EZZyTiMA-cwGM-8ug5PcWUq4xpKoMcXITdMpaOJ9yFCefC92XKR_SZQ04BRg6HA84D7JBH58aFQpyv-DWnI2WcoJgU8XPAP_9WTZihghnGIwX6wj55GAm_vtU1-3V3-3jzo7p_-P7z5vq-cqoxuVICtJQGO9Xp1qFUwjRaeul1I9vOYN242oKTVreAsN0aKW3XbgdrXDMMIOo1u3z1PaT4e0HK_RTI4Vguw7hQr4xtjbBWN4XavlJdikQJfX9IYYJ07KXoTzn0-_49h_6UwwkvORThxduOZTvh8F_2_vj6L4-Aidg</recordid><startdate>202401</startdate><enddate>202401</enddate><creator>Zhou, Qiang</creator><creator>Liu, Xiang</creator><creator>Yang, Xian</creator><creator>Huang, Xiao-Hui</creator><creator>Wu, Yan-Zi</creator><creator>Tao, Ying-Ying</creator><creator>Wei, Meng</creator><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>7X8</scope></search><sort><creationdate>202401</creationdate><title>Effectiveness and safety of short-term anticoagulant regimens after left atrial appendage occlusion: A systematic review and meta-analysis</title><author>Zhou, Qiang ; Liu, Xiang ; Yang, Xian ; Huang, Xiao-Hui ; Wu, Yan-Zi ; Tao, Ying-Ying ; Wei, Meng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c258t-20a4118e72746ce1208541f1f451678e35c39ac1946aeabb811976bd98c5dda03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Anticoagulants - adverse effects</topic><topic>Atrial Appendage - surgery</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - surgery</topic><topic>Hemorrhage - chemically induced</topic><topic>Humans</topic><topic>Ischemic Attack, Transient</topic><topic>Retrospective Studies</topic><topic>Stroke - epidemiology</topic><topic>Stroke - etiology</topic><topic>Stroke - prevention & control</topic><topic>Thrombosis - complications</topic><topic>Treatment Outcome</topic><topic>Warfarin - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhou, Qiang</creatorcontrib><creatorcontrib>Liu, Xiang</creatorcontrib><creatorcontrib>Yang, Xian</creatorcontrib><creatorcontrib>Huang, Xiao-Hui</creatorcontrib><creatorcontrib>Wu, Yan-Zi</creatorcontrib><creatorcontrib>Tao, Ying-Ying</creatorcontrib><creatorcontrib>Wei, Meng</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Thrombosis research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhou, Qiang</au><au>Liu, Xiang</au><au>Yang, Xian</au><au>Huang, Xiao-Hui</au><au>Wu, Yan-Zi</au><au>Tao, Ying-Ying</au><au>Wei, Meng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness and safety of short-term anticoagulant regimens after left atrial appendage occlusion: A systematic review and meta-analysis</atitle><jtitle>Thrombosis research</jtitle><addtitle>Thromb Res</addtitle><date>2024-01</date><risdate>2024</risdate><volume>233</volume><spage>88</spage><epage>98</epage><pages>88-98</pages><issn>0049-3848</issn><eissn>1879-2472</eissn><abstract>Left atrial appendage occlusion (LAAO) provides an alternative for poor candidates of long-term oral anticoagulant (OAC) therapy; however, anticoagulant therapy after surgical procedures has limited use due to associated uncertainties. We aimed to evaluate the effectiveness and safety of the short-term use of direct oral anticoagulant (DOAC) and warfarin after LAAO.
Electronic databases such as PubMed, Embase, Medline, and Cochrane Library databases were searched up to November 11, 2022. Our study compared DOAC therapy and warfarin in patients after LAAO. A meta-analysis was conducted with the Review Manager software (version 5.4).
The meta-analysis included 13 cohort studies with a total of 32,607 patients. Our findings indicated that the incidence of stroke/TIA/SE, peri-device leaks>5 mm, device-related thrombosis, and all-cause mortality were not significantly different between the two groups after LAAO (P > 0.05). The DOAC group had a significantly lower incidence of major bleeding (OR = 0.83, 95 % CI: 0.74-0.94, P = 0.003), any bleeding (OR = 0.34, 95 % CI: 0.23-0.51, P < 0.001), stroke/TIA/SE and major bleeding (OR = 0.57, 95 % CI: 0.34-0.95, P = 0.03), and any major adverse event (OR = 0.89, 95 % CI:0.82-0.97, P = 0.010) than the warfarin group. The subgroup analysis revealed that the rate of stroke/TIA/SE was similar in the two groups in terms of the different regions, follow-up time, study type, anticoagulant strategy, and bleeding risk. The incidence of major bleeding in the DOAC group was significantly lower than that in the warfarin group in North America, as well as at follow-up period ≤6 months, retrospective cohort, HAS-BLED average score ≥ 3. In addition, the risk of major bleeding was higher with the combination of OAC and single antiplatelet therapy (SAPT) than with OAC alone. Finally, in the North American region, retrospective cohort, and HAS-BLED average score ≥ 3, the incidence of any serious adverse event in the DOAC group was still significantly lower than that in the warfarin group.
Compared to warfarin, DOAC reduced the risk of major bleeding and any serious adverse event in patients after LAAO. This advantage was particularly notable in North America and high-risk populations for bleeding. In addition, the incidence of device-related thrombosis, peri-device leaks, stroke/TIA/SE and all-cause mortality were similar in both groups. The risk of major bleeding was lower in patients taking OAC alone compared with those taking OAC plus SAPT, without increasing the risk of thrombosis.</abstract><cop>United States</cop><pmid>38035647</pmid><doi>10.1016/j.thromres.2023.10.021</doi><tpages>11</tpages></addata></record> |
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| ispartof | Thrombosis research, 2024-01, Vol.233, p.88-98 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Anticoagulants - adverse effects Atrial Appendage - surgery Atrial Fibrillation - complications Atrial Fibrillation - drug therapy Atrial Fibrillation - surgery Hemorrhage - chemically induced Humans Ischemic Attack, Transient Retrospective Studies Stroke - epidemiology Stroke - etiology Stroke - prevention & control Thrombosis - complications Treatment Outcome Warfarin - adverse effects |
| title | Effectiveness and safety of short-term anticoagulant regimens after left atrial appendage occlusion: A systematic review and meta-analysis |
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