Associazione Nazionale Medici Cardiologi Ospedalieri



Left Atrial Appendage Closure versus Triple Antithrombotic Therapy in Patients with Long Time Indication to Dual Antiplatelet Therapy

Vella Ciro Salvatore Milano (Milano) – Irccs Ospedale | Festorazzi Costanza Milano (Milano) – Irccs Ospedale San Raffaele | Ancona Marco Bruno Milano (Milano) – Irccs Ospedale San Raffaele Milano | Bellini Barbara Milano (Milano) – Irccs Ospedale San Raffaele Milano | Ferri Luca Angelo Milano (Milano) – Irccs Ospedale San Raffaele Milano | Russo Filippo Milano (Milano) – Irccs Ospedale San Raffaele Milano | Ghizzoni Giulia Milano (Milano) – Irccs Ospedale San Raffaele Milano | Gentile Domitilla Milano (Milano) – Irccs Ospedale San Raffaele Milano | Montorfano Matteo Milano (Milano) – Irccs Ospedale San Raffaele Milano |

Introduction: Recent guidelines suggest a limited duration of triple antithrombotic therapy (TAT) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) at elevated bleeding risk. Indeed, in patients who are also at elevated thrombotic risk and with indication to prolonged dual antiplatelet therapy, percutaneous left atrial appendage closure (LAAC) could be a possible safe and effective option to prevent both bleeding and thrombotic events.

Methods: retrospective single-center study enrolling all consecutive patients between September 2012 and February 2020, comparing patients deemed at increased thrombotic and bleeding risk who received LAA percutaneous closure to avoid TAT before or after PCI with patients who received TAT after PCI. The aim of the study was to establish the safety and efficacy of LAAC in comparison to TAT.

Results: A total of 168 patients were included in the study: 56 underwent percutaneous LAAC while 112 were discharged in TAT. Median age was 75 (69-79). TAT patients had a CHA2DS2-VASc score of 4 (3-5) and a mean HAS-BLED score of 3 (2-3), whereas in LAAC patients the mean CHA2DS2-VASc was 4.9 (±1.5) and the mean HAS-BLED was 3.9 (±0.9); the difference in Score Points was statistically significant (p=0.001). The population who underwent LAAC was characterized by a remarkable procedural PCI complexity with a mean DAPT score of 1.4 (±1.3), with respect to the population discharged in TAT which was 0 (0-2). At follow-up (mean follow-up period in days: 727 [489-1000]), four bleeding episodes were recorded in LAAC population in comparison to 16 bleeding episodes observed in TAT population (12.6% vs. 15.4%; p-value=0.142): two bleeding episodes were major in LAAC group and five in TAT group (3.6% vs. 4.8%; p-value=1). One case of stroke (1.8%) occurred in LAAC population and two cases (1.8%) in TAT population (p=1.000).

Conclusions: In a single-centre retrospective study no significant difference was observed in terms of bleeding between TAT and LAAC, in patients at high ischemic and thrombotic risk with indication to prolonged dual antiplatelet therapy after PCI and anticoagulation for AF. Nevertheless, the non statistical trend to reduction of bleeding events in LAAC group might be explored in a larger study population.