Effectiveness of Only Aspirin or Clopidogrel Following Percutaneous Left Atrial Appendage Closure

• Published in: The American journal of cardiology 2019-12, Vol.124 (12), p.1894-1899
• Main Authors: Pouru, Jussi-Pekka, Jaakkola, Samuli, Lund, Juha, Biancari, Fausto, Saraste, Antti, Airaksinen, K.E. Juhani
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Aged, 80 and over; Alcohol; Anticoagulants; Antiplatelet therapy; Aspirin; Aspirin - adverse effects; Aspirin - therapeutic use; Atrial Appendage - surgery; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - drug therapy; Atrial Fibrillation - mortality; Atrial Fibrillation - surgery; Bleeding; Cardiac arrhythmia; Catheter Ablation - methods; Clopidogrel; Clopidogrel - adverse effects; Clopidogrel - therapeutic use; Cohort Studies; Dose-Response Relationship, Drug; Drug Administration Schedule; Embolism; Embolisms; Female; Fibrillation; Finland; Follow-Up Studies; Geriatric Assessment - methods; Hospitals, University; Humans; Hypertension; Ischemia; Kaplan-Meier Estimate; Male; Patients; Platelet Aggregation Inhibitors - therapeutic use; Postoperative Care - methods; Registries; Retrospective Studies; Risk Assessment; Stroke; Stroke - prevention & control; Survival analysis; Thromboembolism; Time Factors; Transient ischemic attack; Treatment Outcome; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2019.08.050

Percutaneous left atrial appendage closure (LAAC) offers a feasible option for stroke prevention in patients with atrial fibrillation (AF), but the optimal antithrombotic treatment strategy for patients with strict contraindications to oral anticoagulation (OAC) remains uncertain. We sought to evaluate short- and long-term outcome after percutaneous LAAC in these very patients discharged on single antiplatelet therapy (SAPT) alone. All consenting AF patients who underwent LAAC from February 2009 to August 2018 in Turku University Hospital, Finland, were enrolled into a prospectively maintained registry. Only patients discharged on SAPT alone were considered for the present analysis. Patients were prospectively followed up to 5 years. The primary end points were thromboembolic event (stroke, transient ischemic attack, or systemic embolism) and intracranial bleeding. Of the 165 LAAC patients, 81 patients (mean age 75 ± 7 years; 44% women; CHA₂DS₂-VASc 4.8 ± 1.4; HAS-BLED 3.2 ± 0.8) were discharged on SAPT only (77 with aspirin 100 mg) after successful LAAC using Amplatzer devices. The duration of SAPT was ≤6 months in 61 (75%) patients. The most common contraindication to OAC was previous intracranial bleeding in 48 (59%) patients. During a mean follow-up of 2.9 years, there were 6 thromboembolic events (2.7 of 100 patient-years; 73% lower-than-predicted rate of thromboembolism). Eight patients (3.6 of 100 patient-years) had a major bleeding event after discharge, and 4 patients had intracerebral bleeding (1.7 of 100 patient-years). At 6-month landmark analysis, freedom from thromboembolism and intracranial bleeding at 3-year follow-up was similar in those with discontinued and life-long SAPT (95.1% vs 88.9% and 97.6% vs 91.7%, respectively). In conclusion, long-term outcome is satisfactory after LAAC in selected AF patients with strict contraindications to OAC receiving short-term SAPT. However, adverse events are not infrequent during early postoperative months.