Jacqueline Saw1, Jens Erik Nielsen-Kudsk2, Martin Bergmann3, Matthew J Daniels4, Apostolos Tzikas5, Mark Reisman6, Bushra S Rana7. 1. Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada. Electronic address: jsaw@mail.ubc.ca. 2. Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. 3. Cardiologicum Hamburg, Hamburg, Germany. 4. Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom; Department of Cardiology, Oxford University NHS Hospitals Trust, Oxford, United Kingdom; Department of Biotechnology, Graduate School of Engineering, Osaka University, Suita, Osaka, Japan. 5. AHEPA University Hospital, Interbalkan European Medical Center, Thessaloniki, Greece. 6. Division of Cardiology, University of Washington Medical Center, Seattle, Washington. 7. Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
Abstract
OBJECTIVES: The aim of this study is to review the evidence on the use of antithrombotic therapy and risk of device-related thrombosis after left atrial appendage closure. BACKGROUND: Left atrial appendage closure (LAAC) is increasingly performed for stroke prevention in patients with nonvalvular atrial fibrillation, especially those who cannot tolerate or are ineligible for oral anticoagulation. METHODS: After device implantation for LAAC, different antithrombotic regimens with varying duration of therapy are currently used. Such selection depends on patients' risk for bleeding and physicians' choice. RESULTS: Device-related thrombosis remains an Achilles' heel of LAAC, and the etiology remains incompletely understood. Dual-antiplatelet therapy, and direct oral anticoagulation may have similar safety and device-related thrombosis occurrence in real-world LAAC registries compared with warfarin and aspirin. Device imaging surveillance should be routinely performed to assess for device-related thrombosis, which if diagnosed should be treated aggressively, as it is associated with higher thromboembolic risks. CONCLUSIONS: Given the uncertainties and therapeutic dilemma, the authors provide an in-depth discussion of the options and rationale for antithrombotic therapy post-LAAC.
OBJECTIVES: The aim of this study is to review the evidence on the use of antithrombotic therapy and risk of device-related thrombosis after left atrial appendage closure. BACKGROUND: Left atrial appendage closure (LAAC) is increasingly performed for stroke prevention in patients with nonvalvular atrial fibrillation, especially those who cannot tolerate or are ineligible for oral anticoagulation. METHODS: After device implantation for LAAC, different antithrombotic regimens with varying duration of therapy are currently used. Such selection depends on patients' risk for bleeding and physicians' choice. RESULTS: Device-related thrombosis remains an Achilles' heel of LAAC, and the etiology remains incompletely understood. Dual-antiplatelet therapy, and direct oral anticoagulation may have similar safety and device-related thrombosis occurrence in real-world LAAC registries compared with warfarin and aspirin. Device imaging surveillance should be routinely performed to assess for device-related thrombosis, which if diagnosed should be treated aggressively, as it is associated with higher thromboembolic risks. CONCLUSIONS: Given the uncertainties and therapeutic dilemma, the authors provide an in-depth discussion of the options and rationale for antithrombotic therapy post-LAAC.
Authors: Guy Rozen; Gilad Margolis; Ibrahim Marai; Ariel Roguin; Eldad Rahamim; David Planer; Edwin Kevin Heist; Offer Amir; Ilgar Tahiroglu; Jeremy Ruskin; Moussa Mansour; Gabby Elbaz-Greener Journal: Front Cardiovasc Med Date: 2022-09-13