Journal Article

Safety and Efficacy of Single Versus Dual Antiplatelet Therapy After Left Atrial Appendage Occlusion

Golino, Paolo, Rapacciuolo, Antonio, Patti, Giuseppe, Mangieri, Antonio, Pagnotta, Paolo Antonio, Colombo, Antonio, Brscic, Elvis, Pasceri, Vincenzo, Russo, Vincenzo, Casu, Gavino, Sticchi, Alessandro, Verolino, Giuseppe, Vizzi, Vincenzo, Boccuzzi, Giacomo

2020

Overview

The optimal antiplatelet strategy after left atrial appendage (LAA) occlusion able to protect from device-related thrombosis, paying the lowest price in terms of bleeding increase, is unclear. In a real-world, observational study we performed a head-to-head comparison of single versus dual antiplatelet therapy (SAPT vs DAPT) in patients who underwent LAA occlusion. We included 610 consecutive patients, stratified according to the type of post-procedural antiplatelet therapy (280 on SAPT and 330 on DAPT). Primary outcome measure was the incidence of the net composite end point including Bleeding Academic Research Consortium classification 3-5 bleeding, major adverse cardiovascular events or device-related thrombosis at 1-year follow-up. The use of SAPT compared with DAPT was associated with similar incidence of the primary net composite end point (9.3% vs 12.7% p = 0.22), with an adjusted hazard ratio (HR) of 0.69, 95% confidence interval 0.41 to 1.15; p = 0.15) at multivariate analysis. However, SAPT significantly reduced Bleeding Academic Research Consortium classification 3-5 bleeding (2.9% vs 6.7%, p = 0.038; adjusted HR 0.37, 0.16 to 0.88; p = 0.024). The occurrence of ischemic events (major adverse cardiovascular events or device-related thrombosis) was not significantly different between the 2treatment strategies (7.8% vs 7.4%; adjusted HR 1.34, 0.70 to 2.55; p = 0.38). In patients who underwent LAA occlusion, post-procedural use of SAPT instead of DAPT was associated with reduction of bleeding complications, with no significant increase in the risk of thrombotic events. These hypothesis-generating findings should be confirmed in a specific, randomized study.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Anticoagulants / Antiplatelet therapy / Aspirin / Bleeding / Cardiac arrhythmia / Classification / Confidence intervals / Consortia / Contraindications / Heart attacks / Hypertension / Intervention / Ischemia / Multivariate analysis / Occlusion / Patients / Stroke / Therapy / Thrombosis / Variables