Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion
This study evaluated the long-term efficacy of a standard antithrombotic strategy versus half-dose direct oral anticoagulation (DOAC) after Watchman implantation. No consensus currently exists on the selection of the most effective antithrombotic strategy to prevent device-related thrombosis (DRT) i...
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| Veröffentlicht in: | JACC. Cardiovascular interventions 2021-11, Vol.14 (21), p.2353-2364 |
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| creator | Della Rocca, Domenico G. Magnocavallo, Michele Di Biase, Luigi Mohanty, Sanghamitra Trivedi, Chintan Tarantino, Nicola Gianni, Carola Lavalle, Carlo Van Niekerk, Christoffel Johannes Romero, Jorge Briceño, David F. Bassiouny, Mohamed Al-Ahmad, Amin Burkhardt, J. David Natale, Veronica N. Gallinghouse, G. Joseph Del Prete, Armando Forleo, Giovanni B. Sanchez, Javier Lakkireddy, Dhanunjaya Horton, Rodney P. Gibson, Douglas N. Natale, Andrea |
| description | This study evaluated the long-term efficacy of a standard antithrombotic strategy versus half-dose direct oral anticoagulation (DOAC) after Watchman implantation.
No consensus currently exists on the selection of the most effective antithrombotic strategy to prevent device-related thrombosis (DRT) in patients undergoing endocardial left atrial appendage closure.
After successful left atrial appendage closure, consecutive patients were prescribed a standard antithrombotic strategy (SAT) or long-term half-dose DOAC (hdDOAC). The primary composite endpoint was DRT and thromboembolic (TE) and bleeding events.
Overall, 555 patients (mean age 75 ± 8 years, 63% male; median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category] score 4 [interquartile range (IQR): 3-6]; median HAS-BLED [hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol] score 3 [IQR: 2-4]) were included. Patients were categorized into 2 groups (SAT: n = 357 vs hdDOAC: n = 198). Baseline clinical characteristics were similar between groups. The median follow-up duration was 13 months (IQR: 12-15 months). DRT occurred in 12 (2.1%) patients, all in the SAT group (3.4% vs 0.0%; log-rank P = 0.009). The risk of nonprocedural major bleeding was significantly more favorable in the hdDOAC group (0.5% vs. 3.9%; log-rank P = 0.018). The rate of the primary composite endpoint of DRT and TE and major bleeding events was 9.5% in SAT patients and 1.0% in hdDOAC patients (HR: 9.8; 95% CI: 2.3-40.7; P = 0.002).
After successful Watchman implantation, long-term half-dose DOAC significantly reduced the risk of the composite endpoint of DRT and TE and major bleeding events compared with a standard, antiplatelet-based, antithrombotic therapy.
[Display omitted] |
| doi_str_mv | 10.1016/j.jcin.2021.07.031 |
| format | Article |
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No consensus currently exists on the selection of the most effective antithrombotic strategy to prevent device-related thrombosis (DRT) in patients undergoing endocardial left atrial appendage closure.
After successful left atrial appendage closure, consecutive patients were prescribed a standard antithrombotic strategy (SAT) or long-term half-dose DOAC (hdDOAC). The primary composite endpoint was DRT and thromboembolic (TE) and bleeding events.
Overall, 555 patients (mean age 75 ± 8 years, 63% male; median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category] score 4 [interquartile range (IQR): 3-6]; median HAS-BLED [hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol] score 3 [IQR: 2-4]) were included. Patients were categorized into 2 groups (SAT: n = 357 vs hdDOAC: n = 198). Baseline clinical characteristics were similar between groups. The median follow-up duration was 13 months (IQR: 12-15 months). DRT occurred in 12 (2.1%) patients, all in the SAT group (3.4% vs 0.0%; log-rank P = 0.009). The risk of nonprocedural major bleeding was significantly more favorable in the hdDOAC group (0.5% vs. 3.9%; log-rank P = 0.018). The rate of the primary composite endpoint of DRT and TE and major bleeding events was 9.5% in SAT patients and 1.0% in hdDOAC patients (HR: 9.8; 95% CI: 2.3-40.7; P = 0.002).
After successful Watchman implantation, long-term half-dose DOAC significantly reduced the risk of the composite endpoint of DRT and TE and major bleeding events compared with a standard, antiplatelet-based, antithrombotic therapy.
[Display omitted]</description><identifier>ISSN: 1936-8798</identifier><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2021.07.031</identifier><identifier>PMID: 34656496</identifier><language>eng</language><publisher>NEW YORK: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anticoagulants - adverse effects ; antiplatelet therapy ; aspirin ; Atrial Appendage - diagnostic imaging ; Atrial Fibrillation - complications ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - drug therapy ; Cardiac & Cardiovascular Systems ; Cardiovascular System & Cardiology ; Female ; Fibrinolytic Agents - adverse effects ; Humans ; left atrial appendage ; Life Sciences & Biomedicine ; Male ; oral anticoagulation ; Science & Technology ; stroke ; Stroke - diagnosis ; Stroke - etiology ; Stroke - prevention & control ; thromboembolism ; Treatment Outcome ; Watchman</subject><ispartof>JACC. Cardiovascular interventions, 2021-11, Vol.14 (21), p.2353-2364</ispartof><rights>2021</rights><rights>Copyright © 2021. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>67</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000715082400012</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c466t-f59adab5fcc7221adc325a6b73da95f3d90fb93dd404a549d8340d4d4d711f4f3</citedby><cites>FETCH-LOGICAL-c466t-f59adab5fcc7221adc325a6b73da95f3d90fb93dd404a549d8340d4d4d711f4f3</cites><orcidid>0000-0001-9883-0114</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jcin.2021.07.031$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3554,27933,27934,39267,46004</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34656496$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Della Rocca, Domenico G.</creatorcontrib><creatorcontrib>Magnocavallo, Michele</creatorcontrib><creatorcontrib>Di Biase, Luigi</creatorcontrib><creatorcontrib>Mohanty, Sanghamitra</creatorcontrib><creatorcontrib>Trivedi, Chintan</creatorcontrib><creatorcontrib>Tarantino, Nicola</creatorcontrib><creatorcontrib>Gianni, Carola</creatorcontrib><creatorcontrib>Lavalle, Carlo</creatorcontrib><creatorcontrib>Van Niekerk, Christoffel Johannes</creatorcontrib><creatorcontrib>Romero, Jorge</creatorcontrib><creatorcontrib>Briceño, David F.</creatorcontrib><creatorcontrib>Bassiouny, Mohamed</creatorcontrib><creatorcontrib>Al-Ahmad, Amin</creatorcontrib><creatorcontrib>Burkhardt, J. David</creatorcontrib><creatorcontrib>Natale, Veronica N.</creatorcontrib><creatorcontrib>Gallinghouse, G. Joseph</creatorcontrib><creatorcontrib>Del Prete, Armando</creatorcontrib><creatorcontrib>Forleo, Giovanni B.</creatorcontrib><creatorcontrib>Sanchez, Javier</creatorcontrib><creatorcontrib>Lakkireddy, Dhanunjaya</creatorcontrib><creatorcontrib>Horton, Rodney P.</creatorcontrib><creatorcontrib>Gibson, Douglas N.</creatorcontrib><creatorcontrib>Natale, Andrea</creatorcontrib><title>Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC-CARDIOVASC INTE</addtitle><addtitle>JACC Cardiovasc Interv</addtitle><description>This study evaluated the long-term efficacy of a standard antithrombotic strategy versus half-dose direct oral anticoagulation (DOAC) after Watchman implantation.
No consensus currently exists on the selection of the most effective antithrombotic strategy to prevent device-related thrombosis (DRT) in patients undergoing endocardial left atrial appendage closure.
After successful left atrial appendage closure, consecutive patients were prescribed a standard antithrombotic strategy (SAT) or long-term half-dose DOAC (hdDOAC). The primary composite endpoint was DRT and thromboembolic (TE) and bleeding events.
Overall, 555 patients (mean age 75 ± 8 years, 63% male; median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category] score 4 [interquartile range (IQR): 3-6]; median HAS-BLED [hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol] score 3 [IQR: 2-4]) were included. Patients were categorized into 2 groups (SAT: n = 357 vs hdDOAC: n = 198). Baseline clinical characteristics were similar between groups. The median follow-up duration was 13 months (IQR: 12-15 months). DRT occurred in 12 (2.1%) patients, all in the SAT group (3.4% vs 0.0%; log-rank P = 0.009). The risk of nonprocedural major bleeding was significantly more favorable in the hdDOAC group (0.5% vs. 3.9%; log-rank P = 0.018). The rate of the primary composite endpoint of DRT and TE and major bleeding events was 9.5% in SAT patients and 1.0% in hdDOAC patients (HR: 9.8; 95% CI: 2.3-40.7; P = 0.002).
After successful Watchman implantation, long-term half-dose DOAC significantly reduced the risk of the composite endpoint of DRT and TE and major bleeding events compared with a standard, antiplatelet-based, antithrombotic therapy.
[Display omitted]</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants - adverse effects</subject><subject>antiplatelet therapy</subject><subject>aspirin</subject><subject>Atrial Appendage - diagnostic imaging</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Cardiac & Cardiovascular Systems</subject><subject>Cardiovascular System & Cardiology</subject><subject>Female</subject><subject>Fibrinolytic Agents - adverse effects</subject><subject>Humans</subject><subject>left atrial appendage</subject><subject>Life Sciences & Biomedicine</subject><subject>Male</subject><subject>oral anticoagulation</subject><subject>Science & Technology</subject><subject>stroke</subject><subject>Stroke - diagnosis</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>thromboembolism</subject><subject>Treatment Outcome</subject><subject>Watchman</subject><issn>1936-8798</issn><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><recordid>eNqNkc2KFDEUhQtRnHH0BVxIloJUmb9KqsBN06OO0NALR7chldzMpKmulElqZN7e9I-zFMkiF_KdA_luVb0luCGYiI-7Zmf81FBMSYNlgxl5Vl2STopaCtw-L3PPRN3JvruoXqW0w1jgXtKX1QXjohW8F5dVvNGjq69DAnTtI5iMtlGPaDVlb4K-W0adfZjQT4hpSeh71pPV0R7f830M-yEUEN3eQ9TzI1q5DBFtwGW0ytEfiuYZSuQO0NaYcUml7HX1wukxwZvzfVX9-PL5dn1Tb7Zfv61Xm9pwIXLt2l5bPbTOGEkp0dYw2moxSGZ13zpme-yGnlnLMdct723HOLa8HEmI445dVe9PvXMMvxZIWe19MjCOeoKwJEXbjpVK2vGC0hNqYkgpglNz9HsdHxXB6uBa7dTBtTq4Vliq4rqE3p37l2EP9inyV24BPpyA3zAEl4yHycAThjGWpMUd5WUitNDd_9Nrn4-LWYdlyiX66RSFovPBQ1TnuD2uVNng__WRP3lzsl0</recordid><startdate>20211108</startdate><enddate>20211108</enddate><creator>Della Rocca, Domenico G.</creator><creator>Magnocavallo, Michele</creator><creator>Di Biase, Luigi</creator><creator>Mohanty, Sanghamitra</creator><creator>Trivedi, Chintan</creator><creator>Tarantino, Nicola</creator><creator>Gianni, Carola</creator><creator>Lavalle, Carlo</creator><creator>Van Niekerk, Christoffel Johannes</creator><creator>Romero, Jorge</creator><creator>Briceño, David F.</creator><creator>Bassiouny, Mohamed</creator><creator>Al-Ahmad, Amin</creator><creator>Burkhardt, J. David</creator><creator>Natale, Veronica N.</creator><creator>Gallinghouse, G. Joseph</creator><creator>Del Prete, Armando</creator><creator>Forleo, Giovanni B.</creator><creator>Sanchez, Javier</creator><creator>Lakkireddy, Dhanunjaya</creator><creator>Horton, Rodney P.</creator><creator>Gibson, Douglas N.</creator><creator>Natale, Andrea</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><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><orcidid>https://orcid.org/0000-0001-9883-0114</orcidid></search><sort><creationdate>20211108</creationdate><title>Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion</title><author>Della Rocca, Domenico G. ; Magnocavallo, Michele ; Di Biase, Luigi ; Mohanty, Sanghamitra ; Trivedi, Chintan ; Tarantino, Nicola ; Gianni, Carola ; Lavalle, Carlo ; Van Niekerk, Christoffel Johannes ; Romero, Jorge ; Briceño, David F. ; Bassiouny, Mohamed ; Al-Ahmad, Amin ; Burkhardt, J. David ; Natale, Veronica N. ; Gallinghouse, G. 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David</creatorcontrib><creatorcontrib>Natale, Veronica N.</creatorcontrib><creatorcontrib>Gallinghouse, G. Joseph</creatorcontrib><creatorcontrib>Del Prete, Armando</creatorcontrib><creatorcontrib>Forleo, Giovanni B.</creatorcontrib><creatorcontrib>Sanchez, Javier</creatorcontrib><creatorcontrib>Lakkireddy, Dhanunjaya</creatorcontrib><creatorcontrib>Horton, Rodney P.</creatorcontrib><creatorcontrib>Gibson, Douglas N.</creatorcontrib><creatorcontrib>Natale, Andrea</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><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>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Della Rocca, Domenico G.</au><au>Magnocavallo, Michele</au><au>Di Biase, Luigi</au><au>Mohanty, Sanghamitra</au><au>Trivedi, Chintan</au><au>Tarantino, Nicola</au><au>Gianni, Carola</au><au>Lavalle, Carlo</au><au>Van Niekerk, Christoffel Johannes</au><au>Romero, Jorge</au><au>Briceño, David F.</au><au>Bassiouny, Mohamed</au><au>Al-Ahmad, Amin</au><au>Burkhardt, J. David</au><au>Natale, Veronica N.</au><au>Gallinghouse, G. Joseph</au><au>Del Prete, Armando</au><au>Forleo, Giovanni B.</au><au>Sanchez, Javier</au><au>Lakkireddy, Dhanunjaya</au><au>Horton, Rodney P.</au><au>Gibson, Douglas N.</au><au>Natale, Andrea</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><stitle>JACC-CARDIOVASC INTE</stitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2021-11-08</date><risdate>2021</risdate><volume>14</volume><issue>21</issue><spage>2353</spage><epage>2364</epage><pages>2353-2364</pages><issn>1936-8798</issn><eissn>1876-7605</eissn><abstract>This study evaluated the long-term efficacy of a standard antithrombotic strategy versus half-dose direct oral anticoagulation (DOAC) after Watchman implantation.
No consensus currently exists on the selection of the most effective antithrombotic strategy to prevent device-related thrombosis (DRT) in patients undergoing endocardial left atrial appendage closure.
After successful left atrial appendage closure, consecutive patients were prescribed a standard antithrombotic strategy (SAT) or long-term half-dose DOAC (hdDOAC). The primary composite endpoint was DRT and thromboembolic (TE) and bleeding events.
Overall, 555 patients (mean age 75 ± 8 years, 63% male; median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category] score 4 [interquartile range (IQR): 3-6]; median HAS-BLED [hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol] score 3 [IQR: 2-4]) were included. Patients were categorized into 2 groups (SAT: n = 357 vs hdDOAC: n = 198). Baseline clinical characteristics were similar between groups. The median follow-up duration was 13 months (IQR: 12-15 months). DRT occurred in 12 (2.1%) patients, all in the SAT group (3.4% vs 0.0%; log-rank P = 0.009). The risk of nonprocedural major bleeding was significantly more favorable in the hdDOAC group (0.5% vs. 3.9%; log-rank P = 0.018). The rate of the primary composite endpoint of DRT and TE and major bleeding events was 9.5% in SAT patients and 1.0% in hdDOAC patients (HR: 9.8; 95% CI: 2.3-40.7; P = 0.002).
After successful Watchman implantation, long-term half-dose DOAC significantly reduced the risk of the composite endpoint of DRT and TE and major bleeding events compared with a standard, antiplatelet-based, antithrombotic therapy.
[Display omitted]</abstract><cop>NEW YORK</cop><pub>Elsevier Inc</pub><pmid>34656496</pmid><doi>10.1016/j.jcin.2021.07.031</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-9883-0114</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1936-8798 |
| ispartof | JACC. Cardiovascular interventions, 2021-11, Vol.14 (21), p.2353-2364 |
| issn | 1936-8798 1876-7605 |
| language | eng |
| recordid | cdi_pubmed_primary_34656496 |
| source | MEDLINE; Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Access via ScienceDirect (Elsevier); Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Aged, 80 and over Anticoagulants - adverse effects antiplatelet therapy aspirin Atrial Appendage - diagnostic imaging Atrial Fibrillation - complications Atrial Fibrillation - diagnosis Atrial Fibrillation - drug therapy Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Female Fibrinolytic Agents - adverse effects Humans left atrial appendage Life Sciences & Biomedicine Male oral anticoagulation Science & Technology stroke Stroke - diagnosis Stroke - etiology Stroke - prevention & control thromboembolism Treatment Outcome Watchman |
| title | Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion |
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