Reduced Direct Oral Anticoagulant Dose versus Dual Antiplatelet Therapy After Left Atrial Appendage Closure in Patients With Non-Valvular Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Autor:	Lima NA; Department of Medicine, Christus University Center, Fortaleza, Ceará, Brazil. Electronic address: nagilaalves2w@gmail.com., Filho FWPA; Department of Medicine, Federal University of Ceará, Sobral, Ceará, Brazil., Mendes BX; Department of Medicine, Christus University Center, Fortaleza, Ceará, Brazil., Neto VLM; Department of Medicine, Federal University of Ceará, Sobral, Ceará, Brazil., d'Avila ALB; Departments of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2024 Nov 22. Date of Electronic Publication: 2024 Nov 22.
DOI:	10.1016/j.hrthm.2024.11.035
Abstrakt:	Background: Left atrial appendage closure is an alternative therapy for patients with nonvalvular atrial fibrillation who are not eligible for long-term oral anticoagulation. However, the optimal therapy after this procedure is still controversial, especially in a subgroup of patients with severe renal dysfunction. Objective: We aimed to evaluate the use of low dose oral anticoagulants (l-DOAC) versus dual antiplatelet therapy (DAPT) after left atrial appendage closure (LAAC) in patients with nonvalvular atrial fibrillation. Methods: We systematically searched PubMed, Embase and Cochrane. Outcomes were the incidence of device-related thrombus (DRT), major bleeding, stroke, cardiovascular mortality, all-cause mortality, thromboembolic events (DRT, ischemic stroke, TIA, peripheral thromboembolism), and the composite outcome of thromboembolic events and major bleeding. Risk ratios (RRs) with 95% confidence intervals were calculated using a random effects model. Review Manager 5.4.1 was used for statistical analyses. Heterogeneity was assessed with I2 statistics. Results: A total of 1,015 participants from 2 randomized controlled trials (RTCs) and 3 non-randomized cohorts were included. The incidence of DRT was significantly reduced with l-DOAC relative to DAPT (0.81% vs 5.08%, respectively; RR 0.37; 95% CI 0.15-0.94; p=0.04; I 2 =0%). We also found the patients who used l-DOAC had a reduction in the composite outcomes of thromboembolic events and major bleeding (1.41% vs 11.13%; RR 0.14; 95% CI 0.05-0.36; p<0.0001; I 2 =0%). Conclusion: In this systematic review and meta-analysis, the use of l-DOACs in patients with non-valvular AF who underwent LAAC reduces the occurrence of the DRT and composite outcomes of thromboembolic events and major bleeding. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu