A comparison of simplified or conventional antithrombotic regimens after left atrial appendage closure in patients at high bleeding risk: the PLATEBRISK study.

Autor: Antúnez-Muiños P; Hospital Clinico Universitario de Salamanca, CIBERCV, IBSAL, Salamanca, Spain., López-Tejero S; Hospital Clinico Universitario de Salamanca, CIBERCV, IBSAL, Salamanca, Spain., Cepas-Guillén P; Servicio de Cardiología, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain., Mon-Noboa M; Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain., Ruiz-Nodar JM; Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.; Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain., Andrés-Lalaguna L; Hospital Universitari i Politecnic La Fe, Centro de Investigación Biomedica en Red (CIBERCV), Valencia, Spain., Rivero F; Cardiac Department, Hospital Universitario de La Princesa, Madrid, Spain., Córdoba-Soriano JG; Servicio de Cardiología, Hospital General Universitario de Albacete, Albacete, Spain., Amat-Santos IJ; CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain., Caneiro-Queija B; Complejo Hospitalario Universitario Alvaro Cunqueiro, Vigo, Spain., Sánchez DM; Department of Cardiology, Hospital Central de La Defensa, Madrid, Spain., Sánchez JJ; Department of Cardiology, Miguel Servet University Hospital, Zaragoza, Spain., Mezcua FT; Unidad de Hemodinámica, Servicio de Cardiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain., Blanco-Fernández F; Hospital Clinico Universitario de Salamanca, CIBERCV, IBSAL, Salamanca, Spain., Sánchez JS; Cardiac Department, Hospital Universitario de La Princesa, Madrid, Spain., Moreno-Ambroj C; Unidad de Hemodinámica Cardíaca, Servicio de Cardiología, Hospital Universitario Joan XXIII, Tarragona, Spain., Estévez-Loureiro R; Complejo Hospitalario Universitario Alvaro Cunqueiro, Vigo, Spain., Nombela-Franco L; Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain., Freixa-Rofastes X; Servicio de Cardiología, Instituto Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain., Cruz-González I; Hospital Clinico Universitario de Salamanca, CIBERCV, IBSAL, Salamanca, Spain.
Jazyk: angličtina
Zdroj: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology [EuroIntervention] 2024 Aug 19; Vol. 20 (16), pp. 1018-1028.
DOI: 10.4244/EIJ-D-24-00116
Abstrakt: Background: Antithrombotic treatment (ATT) post-left atrial appendage occlusion (LAAO) remains controversial. Furthermore, most of the patients undergoing LAAO are at a very high bleeding risk.
Aims: This study aimed to compare a simplified versus conventional ATT after LAAO in very high bleeding risk patients.
Methods: This is a multicentre, retrospective study including very high bleeding risk patients, according to the Bleeding Academic Research Consortium (BARC) definition, who underwent LAAO. These included patients at >4% risk of BARC 3 to 5 bleeding or >1% risk of intracranial bleeding after the procedure. Two groups were established based on the discharge ATT. The simplified group included single antiplatelet treatment or no treatment, and the conventional group comprised dual antiplatelet treatment or anticoagulation (combined or not with antiplatelet therapy).
Results: A total of 1,135 patients were included. The mean CHA 2 DS 2 -VASc and HAS-BLED scores were 4.5±1.5 and 3.7±1.0, respectively. There were no differences in the composite endpoint (death, stroke, transient ischaemic attack, device-related thrombus or major bleeding) between the 2 groups (hazard ratio [HR] 0.81, 95% confidence interval [CI]: 0.59-1.11; p=0.188). Although the rate of major bleeding during the first year was numerically lower in the simplified group, it did not reach statistical significance (HR 0.67, 95% CI: 0.41-1.10; p=0.104). Nonetheless, patients with previous major bleeding presented a significantly lower rate of major bleeding when using the simplified treatment (HR 0.61, 95% CI: 0.36-0.99; p=0.049).
Conclusions: In patients with very high bleeding risk, a simplified ATT after LAAO seems to be as effective as conventional protocols. Furthermore, patients with a history of major bleeding experienced a lower risk of major bleeding with the simplified ATT.
Databáze: MEDLINE
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