Impact of intensive versus nonintensive antithrombotic treatment on device-related thrombus after left atrial appendage closure

Philippe Garot; Pedro Cepas-Guillén; Eduardo Flores-Umanzor; Nina Leduc; Vilhemas Bajoras; Nils Perrin; Angela McInerney; Ana Lafond; Julio Farjat-Pasos; Xavi Millán; Sandra Zendjebil; Reda Ibrahim; Pablo Salinas; Ole de Backer; Ignacio Cruz-González; Dabit Arzamendi; Laura Sanchis; Luis Nombela-Franco; Gilles ÓHara; Adel Aminian; Jens Erik Nielsen-Kudsk; Josep Rodés-Cabau; Xavier Freixa

doi:10.1016/j.rec.2024.11.006

Impact of intensive versus nonintensive antithrombotic treatment on device-related thrombus after left atrial appendage closure

Rev Esp Cardiol (Engl Ed). 2024 Dec 5:S1885-5857(24)00351-7. doi: 10.1016/j.rec.2024.11.006. Online ahead of print.

[Article in English, Spanish]

Authors

Philippe Garot¹, Pedro Cepas-Guillén², Eduardo Flores-Umanzor³, Nina Leduc⁴, Vilhemas Bajoras⁵, Nils Perrin⁶, Angela McInerney⁷, Ana Lafond⁸, Julio Farjat-Pasos⁹, Xavi Millán¹⁰, Sandra Zendjebil¹¹, Reda Ibrahim⁶, Pablo Salinas⁷, Ole de Backer¹², Ignacio Cruz-González⁸, Dabit Arzamendi¹⁰, Laura Sanchis³, Luis Nombela-Franco⁷, Gilles ÓHara⁹, Adel Aminian⁴, Jens Erik Nielsen-Kudsk¹³, Josep Rodés-Cabau¹⁴, Xavier Freixa³

Affiliations

¹ Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France. Electronic address: [email protected].
² Institut Clínic Cardiovascular (ICCV), Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Interventional Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada. Electronic address: https://x.com/@pedro_cepas.
³ Institut Clínic Cardiovascular (ICCV), Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
⁴ Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
⁵ Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Interventional Cardiology, Division of Cardiology and Vascular Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
⁶ Department of Interventional Cardiology, Montreal Heart Institute, Universite de Montreal, Montreal, Canada.
⁷ Departamento de Cardiología Intervencionista, Instituto Cardiovascular, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IDISCC), Madrid, Spain.
⁸ Servicio de Cardiología Intervencionista, Hospital Universitario de Salamanca, Salamanca, Spain.
⁹ Department of Interventional Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada.
¹⁰ Servicio de Cardiología Intervencionista, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
¹¹ Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France.
¹² Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
¹³ Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
¹⁴ Institut Clínic Cardiovascular (ICCV), Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Interventional Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada.

PMID: 39645198
DOI: 10.1016/j.rec.2024.11.006

Abstract

Introduction and objectives: The optimal antithrombotic therapy (AT) after left atrial appendage closure (LAAC) is debated. We assessed the impact of intensive vs nonintensive AT on the incidence of device-related thrombus (DRT) based on whether the device implantation was classified as optimal or suboptimal.

Methods: This study included patients who underwent successful LAAC in 9 centers. Patients were classified according to the quality of device implantation: optimal (proximal implant without ≥3mm peridevice leak) or suboptimal (distal implant and/or ≥3mm peridevice leak). Postimplant AT was classified as either intensive (dual antiplatelet therapy, anticoagulants, or a combination of both) or nonintensive (no AT or a single antiplatelet therapy). The primary endpoint was the incidence of DRT between the 6th and 12th weeks postprocedure.

Results: A total of 1225 patients underwent LAAC, with 757 (61.8%) achieving optimal device implantation and 468 (38.2%) classified as suboptimal. After a median follow-up of 20 months, the incidence of DRT in the optimal implant group was 2.6% with intensive AT and 3.7% with nonintensive AT (P=.38). In the suboptimal implant group, the incidence of DRT increased to 11.2% with intensive AT and 15.5% with nonintensive AT (P=.19). On multivariate analysis, suboptimal implantation (HR, 4.51; 95%CI, 2.70-7.54, P<.001) but not intensive AT (HR, 0,66; 95%CI, 0.40-1.07, P=.09) emerged as an independent predictor of DRT.

Conclusions: The incidence of DRT after LAAC was higher in patients with suboptimal device implantation. In patients with optimal implantation, the incidence of DRT was low and similar between nonintensive and intensive AT strategies. Large, randomized trials are warranted to confirm these results.

Keywords: Antiagregación plaquetaria; Anticoagulación; Anticoagulants; Antiplatelet agents; Atrial fibrillation; Cierre de la orejuela izquierda; Device-related thrombosis; Fibrilación auricular; Ictus; Left atrial appendage closure; Stroke; Trombosis relacionada con el dispositivo.