Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion

Domenico G. Della Rocca, Michele Magnocavallo, Luigi Di Biase, Sanghamitra Mohanty, Chintan Trivedi, Nicola Tarantino, Carola Gianni, Carlo Lavalle, Christoffel Johannes Van Niekerk, Jorge E. Romero, David F. Briceno Gomez, Mohamed Bassiouny, Amin Al-Ahmad, J. David Burkhardt, Veronica N. Natale, G. Joseph Gallinghouse, Armando Del Prete, Giovanni B. Forleo, Javier Sanchez, Dhanunjaya LakkireddyRodney P. Horton, Douglas N. Gibson, Andrea Natale

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objectives: This study evaluated the long-term efficacy of a standard antithrombotic strategy versus half-dose direct oral anticoagulation (DOAC) after Watchman implantation. Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)2353-2364
Number of pages12
JournalJACC: Cardiovascular Interventions
Volume14
Issue number21
DOIs
StatePublished - Nov 8 2021

Keywords

  • antiplatelet therapy
  • aspirin
  • left atrial appendage
  • oral anticoagulation
  • stroke
  • thromboembolism
  • Watchman

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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