scholarly journals Meta-analysis of postoperative antithrombotic therapy after left atrial appendage occlusion

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052096647
Author(s):  
Shu-yue Li ◽  
Juan Wang ◽  
Xiang Hui ◽  
Huai-jun Zhu ◽  
Bao-yan Wang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Antiplatelet Therapy ◽  
Anticoagulant Therapy ◽  
Cardiovascular Mortality ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Meta Analysis ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion ◽  
All Cause Mortality

Objective This meta-analysis explored the safety and effectiveness of different anticoagulant regimens after left atrial appendage occlusion (LAAO). Methods Databases, such as PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Library, were searched to identify eligible studies according to the inclusion criteria. The incidences of events, including device-related thrombus (DRT) formation, stroke, systemic thromboembolism, bleeding, cardiovascular mortality, and all-cause mortality, were analyzed using R version 3.2.3. Results The screening retrieved 32 studies, including 36 study groups and 4,474 patients. The incidence of outcomes after LAAO was calculated via meta-analysis. In the subgroup analysis, the rates of DRT formation, cardiovascular mortality, and all-cause mortality were significantly different among different antithrombotic methods. Single antiplatelet therapy was associated with the highest rate of adverse events, followed by dual antiplatelet therapy (DAPT). Vitamin K antagonists (VKAs) and new oral anticoagulants (NOACs) carried lower rates of adverse events. Conclusions Anticoagulant therapy had better safety and efficacy than antiplatelet therapy. Thus, for patients with nonabsolute anticoagulant contraindications, anticoagulant therapy rather than DAPT should be actively selected. NOACs displayed potential for further development, and these treatments might represent alternatives to VKAs in the future.

scholarly journals Short-Term Antiplatelet Versus Anticoagulant Therapy After Left Atrial Appendage Occlusion

2020 ◽  
Vol 6 (5) ◽  
pp. 494-506 ◽  
Author(s):  
Mohammed Osman ◽  
Tatiana Busu ◽  
Khansa Osman ◽  
Safi U. Khan ◽  
Matthew Daniels ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Short Term ◽  
Left Atrial Appendage Occlusion

scholarly journals Spontaneously occluded left atrial appendage in a patient with atrial fibrillation and stroke: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 1-4
Author(s):  
Andreas Bugge Tinggaard ◽  
Kasper Korsholm ◽  
Jesper Møller Jensen ◽  
Jens Erik Nielsen-Kudsk
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Transoesophageal Echocardiography ◽  
Similar Efficacy ◽  
Cardiovascular Death ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion ◽  
All Cause Mortality

Abstract Background  The left atrial appendage (LAA) is the main source of thromboembolism in atrial fibrillation (AF). Transcatheter closure is non-inferior to warfarin therapy in preventing stroke. Case summary  A patient with two consecutive strokes associated with AF was referred for transcatheter LAA occlusion (LAAO). Preprocedural cardiac CT and transoesophageal echocardiography demonstrated a spontaneously occluded LAA with a smooth left atrial surface, with stationary results at 6- and 12-month imaging follow-up. Warfarin was discontinued, and life-long aspirin instigated. Discussion  Left atrial appendage occlusion has shown non-inferiority to warfarin for prevention of stroke, cardiovascular death, and all-cause mortality. No benefits from anticoagulation have been demonstrated in patients with embolic stroke of undetermined source. In the present case, we observed that the LAA was occluded and, therefore, treated with aspirin monotherapy assuming similar efficacy as transcatheter LAAO.

scholarly journals TCT-203 Incidence and Clinical Impact of Device Related Thrombus after Percutaneous Left Atrial Appendage Occlusion; A Meta-Analysis

2018 ◽  
Vol 72 (13) ◽  
pp. B86
Author(s):  
Mohamad Adnan Alkhouli ◽  
Tatiana Busu ◽  
Kuldeep Shah ◽  
Mohammed Osman ◽  
Fahad Alqahtani ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Meta Analysis ◽  
Clinical Impact ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion

scholarly journals Length of stay following percutaneous left atrial appendage occlusion: Data from the prospective, multicenter Amplatzer Amulet Occluder Observational Study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255721
Author(s):  
Kerstin Piayda ◽  
Shazia Afzal ◽  
Jens Erik Nielsen-Kudsk ◽  
Boris Schmidt ◽  
Patrizio Mazzone ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Adverse Events ◽  
Observational Study ◽  
Hospital Stay ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Bleeding Complications ◽  
Serious Adverse Events ◽  
Left Atrial Appendage Occlusion

Aims To evaluate factors influencing the length of stay in patients undergoing percutaneous left atrial appendage occlusion (LAAO). Methods and results Patient characteristics, procedural data and the occurrence of serious adverse events were analyzed from the AmplatzerTM AmuletTM Occluder Observational Study. Patients were divided into three groups: same day (S, 0day, n = 60, 5.6%) early (E, 1day, n = 526, 48.9%), regular (R, 2-3days, n = 338, 31.4%) and late (L, ≥4days, n = 152, 14.1%) discharge and followed up for 60 days. Procedure and device related SAE during the in-hospital stay (S: 0.0% vs. E: 1.0% vs. R: 2.1% vs. L: 23%, p<0.0001) were a major trigger for a prolonged in-hospital stay. Of the 37 subjects in the late discharge group with an SAE prior to discharge, cardiac or bleeding complications were the most common underlying conditions, occurring in 26 subjects. Multinomial logistic analysis only identified HAS-BLED score as an independent influencing factor (p = 0.04) for a late discharge. After 60 days, mortality tended to be greatest in the late discharge group (S: 0.0% vs. E: 1.0% vs. R: 1.2% vs. L: 3.3%, p = 0.1066). Conclusion Over half of the subjects receiving an Amplatzer Amulet occluder were discharged within 1 day of the implant procedure. Serious adverse events were a major trigger for a late discharge after LAAO. Increased HAS-BLED score was associated with a prolonged in-hospital stay.

scholarly journals Left atrial appendage occlusion with the Amplatzer™ Amulet™ device: full results of the prospective global observational study

2020 ◽  
Vol 41 (30) ◽  
pp. 2894-2901 ◽  
Author(s):  
David Hildick-Smith ◽  
Ulf Landmesser ◽  
A John Camm ◽  
Hans-Christoph Diener ◽  
Vince Paul ◽  
...  
Keyword(s):  
Adverse Events ◽  
Ischaemic Stroke ◽  
Major Bleeding ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cardiovascular Death ◽  
Atrial Appendage ◽  
Stroke Rate ◽  
Left Atrial Appendage Occlusion

Abstract Aims To evaluate the safety and efficacy of left atrial appendage occlusion (LAAO) with the Amplatzer™ Amulet™ occluder. Methods and results Patients with atrial fibrillation eligible for LAAO were recruited to a prospective global study. Implant procedures were undertaken with echocardiographic guidance. Transoesophageal echocardiography (TOE) was undertaken 1–3 months post-LAAO. Implant and follow-up TOEs were evaluated by a CoreLab. The primary endpoint was a composite of ischaemic stroke and cardiovascular death at 2 years. Serious adverse events were adjudicated by an independent clinical events committee. A total of 1088 patients were enrolled, aged 75.2 ± 8.5 years; 64.5% were male. CHA2DS2-VASc and HAS-BLED scores were 4.2 ± 1.6 and 3.3 ± 1.1, respectively. A total of 71.7% had prior major bleeding, and 82.8% had contraindications to oral anticoagulants. Implant success was 99.1%. Major adverse events (≤7 days post-procedure) occurred in 4.0%, including death (0.3%), stroke (0.4%), major vascular (1.3%), and device embolization (0.2%). A total of 80.2% of patients were discharged on antiplatelet therapy alone. Peridevice flow was &lt;3 mm in 98.4% at follow-up TOE. Device-related thrombus (DRT) was seen in 1.6% of cases. Cardiovascular death or ischaemic stroke occurred in 8.7% of patients at 2 years. The ischaemic stroke rate was 2.2%/year—a 67% reduction compared to the CHA2DS2-VASc predicted rate. Major bleeding (Bleeding Academic Research Consortium type ≥ 3) occurred at rates of 10.1%/year (year 1) and 4.0%/year (year 2). Conclusion Following LAAO with the Amplatzer Amulet device, the ischaemic stroke rate was reduced by 67% compared to the predicted risk. Closure was complete in 98.4% of cases and DRT seen in only 1.6%.

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