SPC365

Antithrombotic strategies after LAA occlusion – is there a winning strategy?

Session: Posters (Sessão 4 - Écran 5) - Risco Cardiovascular 2
Speaker: Ana Beatriz Garcia

Congress: CPC 2022
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.14 Risk Factors and Prevention - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Ana Beatriz Garcia; Sara Couto Pereira; Pedro Silvério António; Joana Brito; Pedro Alves da Silva; Beatriz Valente Silva; Ana Margarida Martins; Catarina Simões de Oliveira; Ana Abrantes; João Fonseca; Miguel Azaredo Raposo; Ana Rita Francisco; João Silva Marques; Miguel Nobre Menezes; Fausto j. Pinto; Pedro Cardoso

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Left atrial appendage occlusion (LAAO) is an alternative for patients (pts) with atrial fibrillation at risk of stroke or embolic events, especially those with hemorrhagic events under anticoagulation therapy or at high bleeding risk. There are several antithrombotic strategies (ATS) after LAAO depending on the reason leading to the procedure and the patient&rsquo;s bleeding risk, but no consensual strategy.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To compare different antithrombotic strategies after LAAO during a 12-year period.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Single center registry of pts who underwent LAAO. We gathered clinical and procedural characteristics, CHA</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sub>2</sub></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Ds</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sub>2</sub></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">VASc and HASBLED scores and antithrombotic therapy. Bleeding events were categorized according to the VARC-3 criteria (minor &lt;2, major &ge;2). Differences in stroke or embolic events were assessed. Different ATS were compared: dual antiplatelet therapy (DAT) for 3 or 6 months; single antiplatelet therapy (SAT); oral anticoagulation (OAC); and OAC for 45 days followed by DAT or SAT (a group excluded for its small size and heterogeneity). Efficacy and safety endpoints were defined as embolic events and major bleeding according to HAS-BLED criteria, respectively. For statistical analysis Chi-Square testing and Kaplan-Meier survival curves were used.&nbsp;</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total 139 pts underwent LAAO (mean age 74&plusmn;8 years, 60,4% male) followed by 4,1&plusmn;2,8-years.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Mean CHADsVASc and HASBLED score was 4,2&plusmn;1,3 and 3,4&plusmn;0,9, respectively. Regarding different ATS after LAAO, 4 major groups (92,1% of all pts) were compared: DAT for 3 (16%) or 6 months (51%) followed by SAT up to 12 months or longer; OAC (19%); SAT (6,1%).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Safety endpoint was verified in 13% of pts. Comparing the different ATS, bleeding events were observed in 8,4% pts under DAT (2,3% vs 6,1% pts with DAT for 3 vs 6 months), 3,8% anticoagulated and 0,8% treated with SAT. Comparing the ATS, there were no significant statistical differences in bleeding events (p=0.354), as well as in major and minor bleeding (p=0,258). No differences concerning hemorrhagic events were seen between 3 and 6 months DAT.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Efficacy endpoint occurred in 2,35% of pts. Regarding the different ATS, embolic events were observed in 1,57% pts under DAT for 6 months and 0,78% under SAT. There were no significant statistical differences (p=0.3) between ATS.&nbsp;</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">No single antithrombotic strategy following LAAO proved to be superior for either efficacy or safety. A tailored regimen should be sought out for each patient.</span></span></span></p>

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