Left Atrial Appendage Closure With Different Antithrombotic Therapies in Patients at High Bleeding Risk: A 10-Year Cohort Study.

BACKGROUND

In this study we aimed to evaluate the safety and efficacy of different antithrombotic strategy after left atrial appendage closure (LAAC) in high bleeding risk patients with nonvalvular atrial fibrillation.

METHODS

In this study we included 893 patients with high bleeding risk who successfully underwent LAAC and categorized them into 4 groups on the basis of postprocedural antithrombotic regimen: single antiplatelet therapy (n = 27) or dual antiplatelet therapy (n = 143), warfarin (n = 97), and non-vitamin K antagonist oral anticoagulants (NOACs; n = 626). Kaplan-Meier survival curves and multivariate Cox regression were used.

RESULTS

During a mean follow-up period of 46.17 months, the NOAC group exhibited superior outcomes: lower incidence of mortality (8.1% vs 10.5% for dual antiplatelet therapy, 18.6% for warfarin, and 14.8% for single antiplatelet therapy; P = 0.011), device-related thrombosis (DRT, 2.4% vs 7.0%, and 4.1%; P = 0.045), major bleeding (0.48% vs 2.1%, 2.0%, and 3.7%; P = 0.027) and major adverse cardiovascular events (5.9% vs 13.3%, 11.3%, and 7.4%; P = 0.012). Rivaroxaban showed greater efficacy in reducing mortality (6.9% vs 13.1%), DRT (1.6% vs 5.7%), and major adverse cardiovascular events (5.0% vs 9.8%), compared with dabigatran (all P < 0.05). The 15-mg dose showed a potential trend in reducing cardiac mortality and DRT (all P > 0.05).

CONCLUSIONS

For high bleeding risk patients after LAAC, NOACs might provide a more favourable balance between thrombotic and bleeding risks, with less DRT and fewer ischemic strokes, without increasing mortality. Compared with the other doses, the 15-mg rivaroxaban group showed a potentially superior trend.

CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry: PID: 263473.