SPC365

Low-dose oral anticoagulation versus dual antiplatelet therapy followed by single antiplatelet therapy in patients submitted to left atrial appendage occlusion

Session: Comunicações Orais - Sessão 02 - Intervenção não coronária
Speaker: André Grazina

Congress: CPC 2023
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: André Grazina; Bárbara Lacerda Teixeira; António Fiarresga; Ruben Ramos; Isabel Cardoso; José Miguel Viegas; Lídia de Sousa; Ana Galrinho; Duarte Cacela; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction:</span></strong> Left atrial appendage occlusion (LAAO) is a therapeutic option for atrial fibrillation (AF) patients who have ischemic events despite therapeutic oral anticoagulation and/ or relative or absolute contraindications to oral anticoagulation. Among the several proposed post-procedural anti-thrombotic regimens, low-dose oral anticoagulation (OAC) and dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) are common. However, the best strategy remains unclear.&nbsp; </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"><strong><span style="color:black">Objectives:</span></strong><span style="color:black"> This analysis aims to compare the ischemic and bleeding events among AF patients treated with LAAO treated with an initial 6-week course of low-dose OAC versus 6-week course of DAPT followed by SAPT. </span></span></span></p>

<h1 style="text-align:justify"><span style="font-size:24pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"><strong>Methods:</strong> </span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Retrospective analysis of AF patients submitted to LAAO in a single tertiary center. The decisions of whether to continue the OAC after the 6-week period and some possible crossover between strategies were made by the assistant cardiologist. One year stroke and major bleeding events were evaluated using a Kaplan-Meier survival curves analysis.</span></span></span></span></span></h1>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Results:</span></span></strong><span style="background-color:white"><span style="color:black"> A total of 87 patients (68% male, mean age 74.8 </span></span><span style="background-color:white"><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span></span><span style="background-color:white"><span style="color:black"> 9.6 years old, 71% with permanent AF) submitted to LAAO were included in this analysis. 46 patients underwent a 6-week course of low-dose OAC and 41 a 6-week course of DAPT followed by SAPT. Baseline characteristics are described in the figure 1 and were similar between the two groups, including the conventional stroke and bleeding prediction scores (CHA<sub>2</sub>DS<sub>2</sub>-VASc 3.80</span></span><span style="background-color:white"><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span></span><span style="background-color:white"><span style="color:black">1.26 vs 4.22</span></span><span style="background-color:white"><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span></span><span style="background-color:white"><span style="color:black">1.51, p0.165; HAS-BLED 3.43</span></span><span style="background-color:white"><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span></span><span style="background-color:white"><span style="color:black">1.11 vs 3.85</span></span><span style="background-color:white"><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span></span><span style="background-color:white"><span style="color:black">0.96, p0.065). Regarding outcomes, the stroke and major bleeding rates at 1 year were not different between the two strategies (p0.882 and p0.240, respectively). However, regarding the major bleeding, the Kaplan-Meier survival curves tend to separate between the groups, in favor of an initial low-dose OAC strategy. </span></span></span></span></p>

<p><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Conclusions:</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> Among patients with AF submitted to LAAO, those treated with an initial 6-week period of low-dose oral anticoagulation do not have higher ischemic risk and seem to have lower bleeding risk than those treated with a 6-week period of dual antiplatelet therapy followed by single antiplatelet therapy. Larger prospective randomized clinical trials are needed to corroborate this data.</span></span></span></span></p>