University of Oulu

Jussi-Pekka Pouru, Samuli Jaakkola, Juha Lund, Fausto Biancari, Antti Saraste, K.E. Juhani Airaksinen, Effectiveness of Only Aspirin or Clopidogrel Following Percutaneous Left Atrial Appendage Closure, The American Journal of Cardiology, Volume 124, Issue 12, 2019, Pages 1894-1899, ISSN 0002-9149, https://doi.org/10.1016/j.amjcard.2019.08.050

Effectiveness of only aspirin or clopidogrel following percutaneous left atrial appendage closure

Saved in:
Author: Pouru, Jussi-Pekka1; Jaakkola, Samuli1; Lund, Juha1;
Organizations: 1Heart Center, Turku University Hospital and University of Turku, Turku, Finland
2Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe202002044515
Language: English
Published: Elsevier, 2019
Publish Date: 2020-09-26
Description:

Abstract

Percutaneous left atrial appendage closure (LAAC) offers a feasible option for stroke prevention in patients with atrial fibrillation (AF), but the optimal antithrombotic treatment strategy for patients with strict contraindications to oral anticoagulation (OAC) remains uncertain. We sought to evaluate short- and long-term outcome after percutaneous LAAC in these very patients discharged on single antiplatelet therapy (SAPT) alone. All consenting AF patients who underwent LAAC from February 2009 to August 2018 in Turku University Hospital, Finland, were enrolled into a prospectively maintained registry. Only patients discharged on SAPT alone were considered for the present analysis. Patients were prospectively followed up to 5 years. The primary end points were thromboembolic event (stroke, transient ischemic attack, or systemic embolism) and intracranial bleeding. Of the 165 LAAC patients, 81 patients (mean age 75 ± 7 years; 44% women; CHA₂DS₂-VASc 4.8 ± 1.4; HAS-BLED 3.2 ± 0.8) were discharged on SAPT only (77 with aspirin 100 mg) after successful LAAC using Amplatzer devices. The duration of SAPT was ≤6 months in 61 (75%) patients. The most common contraindication to OAC was previous intracranial bleeding in 48 (59%) patients. During a mean follow-up of 2.9 years, there were 6 thromboembolic events (2.7 of 100 patient-years; 73% lower-than-predicted rate of thromboembolism). Eight patients (3.6 of 100 patient-years) had a major bleeding event after discharge, and 4 patients had intracerebral bleeding (1.7 of 100 patient-years). At 6-month landmark analysis, freedom from thromboembolism and intracranial bleeding at 3-year follow-up was similar in those with discontinued and life-long SAPT (95.1% vs 88.9% and 97.6% vs 91.7%, respectively). In conclusion, long-term outcome is satisfactory after LAAC in selected AF patients with strict contraindications to OAC receiving short-term SAPT. However, adverse events are not infrequent during early postoperative months.

see all

Series: The American journal of cardiology
ISSN: 0002-9149
ISSN-E: 0002-9149
ISSN-L: 0002-9149
Volume: 124
Issue: 12
Pages: 1894 - 1899
DOI: 10.1016/j.amjcard.2019.08.050
OADOI: https://oadoi.org/10.1016/j.amjcard.2019.08.050
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Subjects:
Funding: This study was funded by the Finnish Foundation for Cardiovascular Research, Helsinki, Finland, and Clinical Research Fund (EVO) of Turku University Hospital, Turku, Finland.
Copyright information: © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/.
  https://creativecommons.org/licenses/by-nc-nd/4.0/