PRescriptiOn PattERns of Oral Anticoagulants in Nonvalvular Atrial Fibrillation (PROPER study)

Introduction: Inappropriate use of oral anticoagulants (OACs) have not been well investigatedand, however, may be frequent in real-world practice in patients with nonvalvular atrial fibrillation (NVAF). This study was designed to evaluate the prescription patterns and appropriateness of OACs in patients with NVAF in real-world clinical settings. Methods: We performed a prospective, observational study (NCT02366338). A total of 148 patients with NVAF were screened for OAC prescription. Appropriateness of prescribing was evaluated using 9 criteria of the Medication Appropriateness Index (MAI): indication, choice, dosage, modalities and practicability of administration, drug–drug interactions, drug–disease interactions, duplication, and duration. For each criterion, the evaluator has to rate whether the medication is (A) appropriate, (B) inappropriate but with limited clinical importance, and (C) inappropriate. Results: Of 148 patients, 73 (50%) were on warfarin (group 1), 39 (26%) were on rivaroxaban (group 2), and 36 (24%) were on dabigatran therapy (group 3). The MAI showed that 83% of group 1, 28% of group 2, and 47% of group 3 patients had at least 1 inappropriate criterion. Moreover, according to the choice criterion, 37% of group 1, 8% of group 2 and 5% of group 3 were rated as inappropriate, and dosage was not appropriate in 77% of group 1, 23% of group 2, and 42% of group 3. Conclusion: Inappropriate drug use is frequent among patients with NVAF not only for warfarin but also for NOACs. Although there is an apparent improvement in thromboprophylaxis of NVAF, much more effort is needed for appropriate use of OACs.

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P4766Edoxaban Treatment in routiNe clinical prActice for patients with atrial fibrillation (AF) in Europe (ETNA-AF-Europe): 1-year follow-up according to body mass index

European Heart Journal ◽

10.1093/eurheartj/ehz745.1142 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Weiss ◽

R De Caterina ◽

P Kelly ◽

P Monteiro ◽

J C Deharo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Weight ◽

Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Normal Weight ◽

Routine Practice ◽

Group 3 ◽

Group 2 ◽

Group 1

Abstract Background Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have substantially improved anticoagulation therapy for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF), and available routine care data have so far broadly confirmed the safety of different NOACs in routine practice. However, such data for edoxaban are scarce, especially in extremely low and high body weight (BW). These extreme BWs may affect the bioavailability, distribution, and half-life of NOACs and, consequently, outcomes of treatment. Methods We analysed outcomes in normal-weight (BMI 18.5–25) vs overweight (BMI 25–30) and obese (BMI >30) patients enrolled into the ETNA-AF-Europe observational study (NCT02944019) collecting information on patients treated with edoxaban in 825 sites in 10 European countries. This snapshot analysis set includes data of 7,672 patients (56.3% of all enrolled patients) which have completed their 1-year follow-up visit (mean follow-up: 343.5 days). Results Median patient age was 74 years for all patients, 76 years for patients with a BMI 18.5–25 (group 1), 75 years for patients with BMI 25–30 (group 2), and 72 for patients with a BMI >30 (group 3). CrCl was 64 mL/min for patients with a BMI 18.5–25, 68 mL/min for patients with BMI 25–30, and 72 mL/min for patients with a BMI >30. The CHA2DS2-VASc (mean 3.1±1.38) and HAS-BLED (mean 2.5±1.10) score did not differ significantly between groups. As expected, diabetes and hypertension were significantly less prevalent in leaner patients and - accordingly - inversely correlated to age. There was no correlation between body weight and life-threatening bleeding (group 1: 0.28%; group 2: 0.40%; group 3: 0.14%). Also, stroke rates (group 1: 0.74%; group 2: 0.81%; group 3: 0.76%) did not differ between groups. Conclusion BMI, within the range here assessed, does not affect 1-year outcomes in European AF patients treated with edoxaban. Acknowledgement/Funding Daiichi Sankyo Europe GmbH, Munich, Germany

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Efficacy and safety of anticoagulant treatment for non-valvular atrial fibrillation in multimorbid patients

Kardiologiia ◽

10.18087/cardio.2020.2.n524 ◽

2020 ◽

Vol 60 (2) ◽

pp. 61-68

Author(s):

N. V. Izmozherova ◽

A. A. Popov ◽

V. M. Bakhtin

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Oral Anticoagulants ◽

Anticoagulant Treatment ◽

Nonvalvular Atrial Fibrillation ◽

Cross Sectional ◽

Group 2 ◽

High Level ◽

Multimorbid Patients ◽

Group 1

Objective. Assessment of the safety and efficacy of anticoagulant treatment in patients with nonvalvular atrial fibrillation (AF) in a multimorbidity setting.Materials and Methods. The cross-sectional study included 104 patients diagnosed with nonvalvular AF and followed in the medical facilities of Yekaterinburg. The subjects were interviewed, anthropometric measurements were made, and the risk of thromboembolic complications was evaluated using the CHA2DS2-VASc score. The Charlson multimorbidity index was calculated, and patients were divided into two groups: Group 1 with a low level of multimorbidity (not more than 5 points) and Group 2 with a high level of multimorbidity (6 points or more). The data are presented as a median and interquartile range (25%; 75%).Results.The study population included 40 males and 64 females. The median age was 71 (62.5; 80) years. The level of multimorbidity was estimated as 5 (3; 6) points. Group 1 included 64 patients, and Group 2 included 40 patients. Thirty-nine percent of the sample patients had a paroxysmal form of AF, 10% had a persistent form, and 51% had permanent AF. The group of patients with a high level of multimorbidity included more patients with permanent AF and fewer patients with paroxysmal AF as compared with a moderate level of multimorbidity (p<0.01). Anticoagulant treatment was indicated for 92 (88.5%) patients. It was administered to 70.7% of patients; 29.3% did not receive it. Among patients receiving anticoagulants, warfarin was administered to 18.5%, and new oral anticoagulants (NOACs) were administered to 81.5%. Complications were reported in 15.2% of anticoagulant treatment cases. Bleeding was reported in 21.7% of cases of warfarin administration and 12.5% of cases of NOAC treatment (p=0.32). The median number of risk factors for bleeding per patient was 5 (4; 5.5). The Charlson index and the total number of risk factors are significantly correlated (R=0.37, p<0.05).Conclusion. In real-world clinical practice in Ekaterinburg, Russia, 7 of 10 patients with AF for whom anticoagulant treatment was indicated actually received it; NOACs are prescribed four times more often than warfarin. With a higher level of multimorbidity, the risk of bleeding under the pressure of anticoagulant treatment increases; thus, NOACs should be preferred over warfarin for treatment of multimorbid patients.

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Impacts of hemoglobin levels and platelet counts on clinical outcomes in patients with atrial fibrillation: oral anticoagulant use for patients with anemia and/or thrombocytopenia

European Heart Journal ◽

10.1093/eurheartj/ehab724.0554 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

T Chao ◽

Y.H Chan ◽

G.Y.H Lip ◽

S.A Chen

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcomes ◽

Major Bleeding ◽

Oral Anticoagulant ◽

Oral Anticoagulants ◽

High Risk Population ◽

Group 3 ◽

Composite Risk ◽

Group 2 ◽

Group 1

Abstract Background Hemoglobin (Hgb) levels and platelet (PLT) counts have beeen associated with adverse clinical outcomes in some patients with cardiovascular conditions. We aimed to assess the risks of clinical events among patients with atrial fibrillation (AF) in relation to Hgb levels and PLT counts. Second, we investigated clinical outcomes on warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) compared to no oral anticoagulant use (non-OAC), in different Hgb and PLT strata. Methods We used medical data from a multi-center healthcare system in Taiwan which included 37,074 AF patients. Patients were categorized into 3 groups based on their Hgb levels and PLT counts: Group 1 (Hgb>10g/dL and PLT>100K/uL; n=29,147), Group 2 (Hgb<10g/dL or PLT<100K/uL; n=7,078) and Group 3 (Hgb<10g/dL and PLT<100K/uL; n=849). Patients in each category were further stratified as 3 groups according to their stroke prevention strategies; that is, non-OAC, warfarin or NOACs. Results A higher Hgb level and/or PLT count was associated with a higher risk of ischemic stroke/systemic embolism (IS/SE), but lower risks of intracranial hemorrhage (ICH) and major bleeding. The composite risks of IS/SE, ICH and major bleeding were higher in Group 3 or Group 2, compared to Group 1 (6.75%/yr versus 6.41%/yr versus 4.13%/yr). Compared to non-OACs, the use of warfarin was not associated with a lower composite risk of IS/SE, ICH and major bleeding in the 3 groups. NOACs were associated with a lower composite risk in Group 1 (aHR 0.68, 95% CI 0.60–0.76) and Group 2 (aHR 0.73, 95% CI 0.53–0.99), but was non-significant in Group 3 (aHR 0.73, 95% CI 0.17–3.07) (Figure). The net clinical benefits were consistently positive in different weight models, in favor of NOAC use, in Group 2 and its subgroups with either anemia or thrombocytopenia. Conclusions AF patients with anemia and/or thrombocytopenia were a high-risk population. Compared to no OAC use, NOACs were associated with significantly better clinical outcomes for patients with advanced anemia (Hgb<10g/dL) or thrombocytopenia (PLT<100K/uL), but not for those with both conditions. Harms or benefits of NOACs should be carefully evaluated and balanced in this population. FUNDunding Acknowledgement Type of funding sources: None.

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Compliance to antithrombotic therapy in elderly and senile patients with atrial fibrillation.

Тромбоз, гемостаз и реология ◽

10.25555/thr.2019.3.0891 ◽

2019 ◽

Cited By ~ 1

Author(s):

М.В. Хруслов ◽

М.А. Карпенко ◽

Т.В. Вавилова ◽

И.В. Пономарева

Keyword(s):

Atrial Fibrillation ◽

Antithrombotic Therapy ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Laboratory Model ◽

Nonvalvular Atrial Fibrillation ◽

Effective Prevention ◽

Group 2 ◽

Group 1

Введение. Приверженность к приему антикоагулянтов является одним из ключевых компонентов эффективной профилактики тромбоэмболических осложнений. Цель исследования: оценка комплаентности пациентов пенсионного возраста, которым назначали прямые оральные антикоагулянты (ПОАК) по поводу неклапанной фибрилляции предсердий (ФП), и выяснение причин ее снижения. Материалы и методы. В ходе исследования осуществляли наблюдение за 244 пациентами с неклапанной ФП. В зависимости от вида принимаемых оральных антикоагулянтов все пациенты были разделены на 2 группы: 1я группа 124 человека, которые принимали ПОАК 2я группа 120 человек, которые принимали варфарин и наблюдались в системе централизованного мониторинга международного нормализованного отношения (МНО). Срок наблюдения составил 1 год. Результаты. Через 1 год от момента назначения препаратов назначения врача соблюдали только 22,6 пациентов 1й группы во 2й группе пациентов никто не прекратил прием варфарина, что указывало на более высокую приверженность к терапии. Заключение. Одним из способов повышения качества и безопасности антитромботической терапии у пациентов, принимающих антагонисты витамина К, является внедрение в клиническую практику системы централизованного мониторинга МНО, которая представляет собой новую клиниколабораторную Introduction. Adherence to anticoagulants is one of the key components of effective prevention of thromboembolic complications. Aim: to assess the compliance of patients of retirement age who were prescribed direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (AF), and to determine the reasons for its reduction. Materials and methods. We monitored 244 patients with nonvalvular AF that were divided into 2 groups: Group 1 124 patients who took DOACs Group 2 120 patients who took warfarin and were observed in the system of centralized monitoring of international normalized ratio (INR). The observation period was 1 year. Results. After 1 year from the moment of drugs prescribing only 22.6 of patients from Group 1 followed the prescription no one patient from Group 2 stopped taking warfarin that indicated a higher adherence to therapy. Conclusion. One of the ways to improve the quality and safety of antithrombotic therapy in patients taking vitamin K antagonists is to introduce into the clinical practice a system of centralized monitoring of INR that is a new clinical and laboratory model of remote interaction between patient and medical specialist.

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Patterns of anticoagulation for atrial fibrillation in cancer patients referred for cardio-oncological evaluation

European Heart Journal ◽

10.1093/ehjci/ehaa946.3269 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Toma ◽

E Rrapaj ◽

S Giovinazzo ◽

M Sarocchi ◽

G Stronati ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cancer Patients ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Creatinine Concentration ◽

Pharmacological Interactions ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Group 1

Abstract Background Direct oral anticoagulants (DOAC) are the standard of care for the prophylaxis of non-valvular atrial fibrillation (NVAF)-cardioembolism, but their use in oncological patients has been limited so far. Methods We retrospectively reviewed the records of the patients referred to two cardio-oncology outpatient units between January 2017 and July 2019, and selected those presenting with NVAF, CHA2DS2-VASc ≥1 for men and ≥2 for women, and cancer on active treatment. The following were considered as contraindications to DOAC: severe chronic kidney disease; anti-neoplastic therapy unknown or with potential moderate-to-severe adverse interactions; cirrhosis or liver metastases. Clinical characteristics of patients on DOAC (group 1), on VKA or LMWH with at least 1 contraindication to DOAC (group 2), and on VKA or LMWH despite not having contraindications to DOAC (group 3) were compared by chi-square or ANOVA. Results Of a total of 3,831 patients, 264 (6.9%) met the inclusion criteria (Figure 1). One-hundred fourteen (43.2%) were in group 1, 61 (23.1%) in group 2 (18 on VKA, 43 on LMWH), and 65 (24.6%) in group 3 (27 on VKA, 38 on LMWH). Anticoagulation was omitted in 24 (9.1%) cases for various reasons: spontaneous bleeding (5), anaemia and/or thrombocytopenia (5), frailty (4), CHA2DS2-VASc 1 (3), pharmacological interactions (1), single episode of NVAF (1); and not clearly motivated in 5 subjects. The only significant difference between the 3 groups was serum creatinine concentration (Table 1). Of note, only 10% of subjects in group 1 received an inappropriate DOAC dose, while LMWH was under-dosed for 18% of patients in group 2 and 31% of patients in group 3 (P=0.002). Conclusions In the setting of a dedicated cardio-oncology consultation, DOAC and VKA are most often appropriately prescribed to cancer patients with NVAF. However, there is residual use of LMWH, not infrequently at non-anticoagulant dosage. This is a non-evidence based common practice in clinical oncology that clearly must be abandoned Figure 1 Funding Acknowledgement Type of funding source: None

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Factors That Determine the Prothrombin Time in Patients With Atrial Fibrillation Receiving Rivaroxaban

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618800830 ◽

2018 ◽

Vol 24 (9_suppl) ◽

pp. 188S-193S

Author(s):

Jen-Hung Huang ◽

Yung-Kuo Lin ◽

Cheng-Chih Chung ◽

Ming-Hsiung Hsieh ◽

Wan-Chun Chiu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Prothrombin Time ◽

Factor Xa ◽

International Normalized Ratio ◽

Biochemical Properties ◽

Study Patient ◽

Group 3 ◽

Multiple Variables ◽

Group 2 ◽

Group 1

Rivaroxaban, a direct factor Xa inhibitor, is widely used to reduce the chance of stroke in patients with atrial fibrillation (AF). It is not clear why the prothrombin time (PT) of the international normalized ratio (INR) fails to correlate with treatment using rivaroxaban in patients with AF. In this study, patient characteristics, the rivaroxaban dosage, AF type, drug history, biochemical properties, and hematological profiles were assessed in patients treated with rivaroxaban. In 69 patients with AF receiving rivaroxaban, 27 (39.1%) patients had a normal INR (≤1.1, group 1), 27 (39.1%) patients had a slightly prolonged INR (1.1∼1.5, group 2), and 15 (21.7%) patients had a significantly prolonged INR (>1.5, group 3). Group 1 patients had a higher incidence of a stroke history than did patients in group 2 ( P = .026) and group 3 ( P = .032). We scored patients with a persistent AF pattern (1 point), paroxysmal AF pattern (0 point), renal function (ie, the creatinine clearance rate in mL/min/1.73 m2 of >60 as 0 points, of 30∼60 as 1 point, and of <30 as 2 points), and no history of stroke (1 point), and we found that group 3 had a higher score than groups 2 or 1 (2.9 ± 0.8, 2.4 ± 0.7, and 2 ± 0.7, respectively; P < .05). There were similar incidences of bleeding, stroke, and unexpected hospitalizations among the 3 groups. The PT of the INR is determined by multiple variables in patients with AF receiving rivaroxaban. Rivaroxaban-treated patients with AF having different INR values may have similar clinical outcomes.

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How is juvenile rheumatic heart disease different: baseline results from a prospective north Indian registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1898 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Mahajan ◽

D.R Prakash Chand Negi

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Funding Source ◽

Thromboembolic Events ◽

Group 3 ◽

Group 2 ◽

Rheumatic Heart ◽

Group 1

Abstract Introduction Juvenile rheumatic heart disease (RHD) refers to RHD in patients <20 years of age. There are no contemporary data highlighting the differences between juvenile and older RHD patients. Purpose We aim to report the age related differences in the pattern, and consequencies of valvular dysfunction in patients of RHD. Methods The 2475 consecutive patients of RHD diagnosed using clinical and echocardiographic criteria were registered prospectively from 2011 till December 2019. Patients were divided into 3 groups according to their age: Group 1 (Juvenile RHD), Group 2 (21–50 years), and Group 2 (>51 years).The data concerning the socio-demographic and clinical profile were recorded systematically, and the nature and severity of valvular dysfunction was assessed by echocardiography. The data were analyzed using the Epi-InfoTM Software. Results Out of 2475 RHD patients, Juvenile RHD comprised of 211 (8.5%) patients. Group 2 and 3 comprised of 1691 (68.3%) and 573 (23.2%) patients respectively. Overall, 1767 (71.4%) patients were females, however this female predilection was less pronounced in juvenile RHD (55.5% females vs 44.5% males) as compared to older groups. Past history of acute rheumatic fever was more commonly recorded in Juvenile RHD group (37.9% vs 18.8% in group 2 and 10% in group 3, p=0.0001). At the time of registration, the presence of advanced heart failure symptoms (dyspnea class III and IV) (11.4% group 1 vs 13.9% group 2 vs 20.6% group 3, p<0.0001), right heart failure symptoms (0.9% group 1 vs 2.5% group 2 vs 7.3% group 3, p<0.01), thromboembolic events (0% group 1 vs 4.1% group 2 vs 3.3% group 3, p<0.01), atrial fibrillation (2.8% group 1 vs 24.5% group 2 vs 45.9% group 3, p<0.0001), and pulmonary hypertension (27.1% group 1 vs 40.3% group 2 vs 51.9% group 3, p<0.01), were all more commonly recorded in non-juvenile older RHD groups. Multivalvular involvement was also less common in juvenile RHD (34.6% vs 42.4% and 44.5%, p=0.04). Mitral regurgitation was the most common lesion in Juvenile RHD followed by aortic regurgitation (68.7% and 40.2% respectively). Stenotic lesions (both mitral and aortic) were present more commonly in older age groups. Conclusion RHD is predominantly a disease of females, however the predilection is less common in juvenile patients. Juvenile RHD predominantly affects the mitral valve and mainly leads to regurgitant lesions. As the age advances, the complications of RHD, mainly heart failure symptoms, thromboembolic events, pulmonary hypertension, and atrial fibrillation, become more common. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Self sponsored registry

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Abstract 15948: Impact of Age on Safety of Radiofrequency Ablation in Patients With Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.15948 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Janet W Elcano ◽

Hui Nam Pak

Keyword(s):

Atrial Fibrillation ◽

Phrenic Nerve Palsy ◽

Adjusted Risk ◽

Ablation Time ◽

Group 4 ◽

Major Complications ◽

Group 3 ◽

Group 2 ◽

The Impact ◽

Group 1

Background: The incidence of atrial fibrillation (AF) is increasing in the elderly population, however, there is paucity of data on the safety outcomes of this patient subgroup thus we sought to investigate on the impact of age on the safety of catheter ablation for AF. Methods and Results: We included 1,293 (male 75%) patients enrolled in Yonsei AF Ablation Cohort database in Seoul, South Korea, from March 2009 to November 2013. We divided the patients into 4 groups according to age (Group 1, aged 17-49, N=295 ; Group 2 50-59, N=421; Group 3 60-69 N=408; and Group 4 ≥ 70, N=169) and evaluated the incidence of procedure related complications. No procedure-related death occurred in this study. There was a trend of increasing incidence of procedure related complications with age noted as follows: Group 1= 3.7%; Group 2= 4.0%; Group 3=6.6%; and Group 4 7.1%, (p= 0.15). There were 28 cases (2.2%) of major complications (Group 1=1.7%, Group 2=1.9%, Group 3=2%, Group 4 4.1%), tamponade being the most common. Major complications in group 4 include: tamponade 4 cases, phrenic nerve palsy 1 case, atrioesophaeal fistula 1 and 3rd degree AV block in 1 patient. Multivariate regression analysis shows ablation time (odds ratio (OR) 1.2 confidence interval (CI)1.0-1.017, p=0.017), procedure time (OR 1.008, CI 1.0-1.15, p=0.04), decreasing eGFR (OR 1.013, CI 1.002-1.026 p=0.018), coronary artery disease (CAD) (OR 1.847, CI 1.003-3.524, p0.04) and age (OR 1.028, CI 1.003-1.055, p=0.03) were associated with increased adjusted risk of total complications. Predictors of major complications include age (OR 1.044, CI 1.003-1.086, p0.02) and ablation time (OR 1.009, CI 0.999-1.000, p=0.033). Conclusion: Our data suggest that incidence of procedural complications in RFA of AF increase with age. Ablation time and age are independent predictors of a major complication.

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Abstract 15073: Best Anticoagulation Strategy for Stroke Prophylaxis in Atrial Fibrillation Patients With Amyloidosis

Circulation ◽

10.1161/circ.142.suppl_3.15073 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sanghamitra Mohanty ◽

CHINTAN G TRIVEDI ◽

Joseph Gallinghouse ◽

Domenico G Della Rocca ◽

Carola Gianni ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

Bleeding Complications ◽

Considerable Proportion ◽

Medical Procedure ◽

Bleeding Events ◽

Full Dose ◽

Half Dose ◽

Group 2 ◽

Group 1

Background: A considerable proportion of elderly patients are known to have coexistent atrial fibrillation (AF) and amyloidosis. Both conditions increase stroke risk. Objective: We evaluated the best anticoagulation strategy in a series of AF patients with amyloidosis. Methods: Consecutive AF patients with coexistent amyloidosis undergoing catheter ablation at our center were included in the analysis. Based on the stroke-prophylaxis approach they were divided into 2 groups; group 1: left atrial appendage occlusion (LAAO) with Watchman and group 2: oral anticoagulation. Following LAAO, all patients remained on full dose non-vitamin K oral anticoagulants (NOAC) for 45 days. Transesophageal echocardiogram (TEE) was performed at 45 days to assess completeness of closure. If the occlusion was complete, patients were kept on aspirin, 81 mg/day for long-term. In case of leak or dense ‘smoke’ in the left atrium (LA) or enlarged LA, they were prescribed half-dose NOAC. NOACs included dabigatran, apixaban, endoxaban and rivaroxaban. Group 2 patients remained on full-dose NOAC during the whole study period (1 year). All patients were prospectively followed up for 1 year. Results: A total of 87 patients were included in the analysis; group 1: 56 and group 2: 31 . CHA 2 DS 2 -VASc score was comparable between the groups (gr. 1: 3.7±1.6 and gr. 2: 3.2±1.7, p=0.18). The most commonly used NOACs were apixaban (45, 51.7%) and rivaroxaban (34, 39%). After the 45-day TEE, 34 patients from group 1 remained on baby-aspirin and 22 on half-dose NOAC. Of the 22, 12 patients had leaks <5 mm, 6 had large LA (mean diameter 5.2±1.4 cm) and 4 patients had dense LA smoke. At 1-year follow-up, 3 stroke and 1 transient ischemic attack were reported in group 1 on baby-aspirin (4/34, 11.8%). No stroke or bleeding complications occurred in the 22 patients on half-dose NOAC. In group 2 patients on full-dose OAC, a total of 5 (5/31, 16.1%) bleeding events (1 subdural hematoma and 4 GI bleedings) were recorded. Additionally, a stroke was reported that happened during brief discontinuation of OAC for another medical procedure. Conclusion: In our series of patients with coexistent AF and amyloidosis, half-dose NOAC following LAA occlusion procedure was observed to be the safest stroke-prophylaxis strategy.

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