Mohammed Osman1, Tatiana Busu1, Khansa Osman2, Safi U Khan1, Matthew Daniels3, David R Holmes4, Mohamad Alkhouli5. 1. Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA. 2. Michigan Health Specialist, Michigan State University, Flint, Michigan, USA. 3. Division of Cardiovascular Medicine, Department of Medicine, University of Oxford, Oxford, United Kingdom. 4. Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. 5. Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. Electronic address: alkhouli.mohamad@mayo.edu.
Abstract
OBJECTIVES: The aim of this study was to compare bleeding, thromboembolic, device-related thrombus (DRT), and all-cause mortality events between patients treated with short-term oral anticoagulation (OAC) and those treated with short-term antiplatelet therapy (APT) following left atrial appendage occlusion (LAAO). BACKGROUND: Short-term OAC is recommended for patients following LAAO. However, in practice many patients receive APT rather than OAC because of excessive bleeding risk. However, the safety and efficacy of APT compared with OAC have been debated. METHODS: A search was conducted of databases for studies comparing OAC with APT following LAAO. The outcomes of interest were all-cause stroke, major bleeding, DRT, and all-cause mortality. Noncomparative studies were pooled into a single study to generate comparisons of the studies' outcomes. Effects measure were pooled using the random-effect model. RESULTS: A total of 83 studies with 12,326 patients (APT, n = 7,900; OAC, n = 4,151) were included. Mean CHA2DS2-VASc and HAS-BLED scores were 4.1 ± 1.6 and 3.0 ± 1.3, respectively. There were no significance differences between the APT and OAC groups with regard to stroke (risk ratio [RR]: 1.04; 95% confidence interval [CI]: 0.54 to 1.98; p = 0.91; I2 = 31%), major bleeding (RR: 1.12; 95% CI: 0.68 to 1.84; p = 0.65; I2 = 53%), DRT (RR: 1.33; 95% CI: 0.74 to 2.39; p = 0.33; I2 = 36%), and all-cause mortality (RR: 1.29; 95% CI: 0.40 to 4.09; p = 0.18; I2 = 36%). These findings persisted in multiple secondary analyses: 1) excluding studies that reported no events; 2) including comparative studies only; 3) excluding patients who were treated with single APT; and 4) removing one study at a time to assess the effect of each study on the overall effect size. There was also no difference in the studies' endpoints among patients who received different LAAO devices. CONCLUSIONS: In a meta-analysis of observational data, there were no differences in the occurrence of stroke, major bleeding DRT, and all-cause mortality in patients treated with short-term OAC or APT following LAAO.
OBJECTIVES: The aim of this study was to compare bleeding, thromboembolic, device-related thrombus (DRT), and all-cause mortality events between patients treated with short-term oral anticoagulation (OAC) and those treated with short-term antiplatelet therapy (APT) following left atrial appendage occlusion (LAAO). BACKGROUND: Short-term OAC is recommended for patients following LAAO. However, in practice many patients receive APT rather than OAC because of excessive bleeding risk. However, the safety and efficacy of APT compared with OAC have been debated. METHODS: A search was conducted of databases for studies comparing OAC with APT following LAAO. The outcomes of interest were all-cause stroke, major bleeding, DRT, and all-cause mortality. Noncomparative studies were pooled into a single study to generate comparisons of the studies' outcomes. Effects measure were pooled using the random-effect model. RESULTS: A total of 83 studies with 12,326 patients (APT, n = 7,900; OAC, n = 4,151) were included. Mean CHA2DS2-VASc and HAS-BLED scores were 4.1 ± 1.6 and 3.0 ± 1.3, respectively. There were no significance differences between the APT and OAC groups with regard to stroke (risk ratio [RR]: 1.04; 95% confidence interval [CI]: 0.54 to 1.98; p = 0.91; I2 = 31%), major bleeding (RR: 1.12; 95% CI: 0.68 to 1.84; p = 0.65; I2 = 53%), DRT (RR: 1.33; 95% CI: 0.74 to 2.39; p = 0.33; I2 = 36%), and all-cause mortality (RR: 1.29; 95% CI: 0.40 to 4.09; p = 0.18; I2 = 36%). These findings persisted in multiple secondary analyses: 1) excluding studies that reported no events; 2) including comparative studies only; 3) excluding patients who were treated with single APT; and 4) removing one study at a time to assess the effect of each study on the overall effect size. There was also no difference in the studies' endpoints among patients who received different LAAO devices. CONCLUSIONS: In a meta-analysis of observational data, there were no differences in the occurrence of stroke, major bleeding DRT, and all-cause mortality in patients treated with short-term OAC or APT following LAAO.
Authors: Yoshinari Enomoto; Varuna K Gadiyaram; Carola Gianni; Rodney P Horton; Chintan Trivedi; Sanghamitra Mohanty; Luigi Di Biase; Amin Al-Ahmad; J David Burkhardt; Arvin Narula; Gwen Janczyk; Matthew J Price; Muhammad R Afzal; Moustapha Atoui; Matthew Earnest; Vijay Swarup; Shephal K Doshi; Sarina van der Zee; Rebecca Fisher; Dhanunjaya R Lakkireddy; Douglas N Gibson; Andrea Natale; Vivek Y Reddy Journal: Heart Rhythm Date: 2016-10-19 Impact factor: 6.343
Authors: Christian Fastner; Lea Hoffmann; Mohamed Aboukoura; Michael Behnes; Siegfried Lang; Martin Borggrefe; Ibrahim Akin; Christoph A Nienaber Journal: BMC Cardiovasc Disord Date: 2018-08-20 Impact factor: 2.298