Afzal S. · Dannenberg L. · Kanschik D. · Kelm M. · Zeus T. · Polzin A.

Author affiliations

Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Düsseldorf, Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany

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Article / Publication Details

First-Page Preview

Received: May 20, 2022
Accepted: October 08, 2022
Published online: December 13, 2022

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 1

ISSN: 0031-7012 (Print)
eISSN: 1423-0313 (Online)

For additional information: https://www.karger.com/PHA

Abstract

Percutaneous left atrial appendage occlusion (LAAO) is an option to reduce the risk of stroke in patients with atrial fibrillation and high bleeding risk. However, device-related thrombosis (DRT) post LAAO is feared as complication. Simard et al. found a very high incidence of DRT compared to other trials. However, antithrombotic regimen and used devices have not been compared between studies. We compared DRT formation, antithrombotic regimen and used device in the recent DRT study, the Amplatzer IDE trial, and the Düsseldorf (DUS) LAAO registry. Occluder thrombosis occurred in 25.3% in the DRT study, 3.8% in the Amulet IDE trial, and 3.3% in the DUS LAAO registry (p < 0.0001). Oral anticoagulation-based regimen was more frequent in the DRT study compared to the DUS LAAO registry, whereas dual antiplatelet regimen was more frequent in the DUS LAAO registry (p < 0.0001). Amplatzer amulet was more frequently used in the DUS LAAO registry as compared to the DRT study (p < 0.0001). DRT is a feared complication after LAAO and seems to be dependent on antiplatelet treatment and underlying device. A clinical study controlling for device and antithrombotic regimen is needed to smash this Gordian knot.

© 2022 S. Karger AG, Basel

References Simard T, Jung RG, Lehenbauer K, Piayda K, Pracon R, Jackson GG, et al. Predictors of device-related thrombus following percutaneous left atrial appendage occlusion. J Am Coll Cardiol. 2021;78(4):297–313. Lakkireddy D, Thaler D, Ellis CR, Swarup V, Sondergaard L, Carroll J, et al. Amplatzer amulet left atrial appendage occluder versus watchman device for stroke prophylaxis (amulet ide): a randomized controlled trial. Circulation. 2021;144(19):1543–52. McIvor F, Wall D. Who watches the WATCHMAN? A case of incomplete endothelialization at 3 years after device implantation. Eur J Cardio-Thoracic Surg. 2019;56(6):1194–5. Dangas GD, Tijssen JGP, Wohrle J, Sondergaard L, Gilard M, Mollmann H, et al. A controlled trial of rivaroxaban after transcatheter aortic-valve replacement. N Engl J Med. 2020;382(2):120–9. Petzold T, Thienel M, Dannenberg L, Mourikis P, Helten C, Ayhan A, et al. Rivaroxaban reduces arterial thrombosis by inhibition of FXa-driven platelet activation via protease activated receptor-1. Circ Res. 2020;126(4):486–500. Flores-Umanzor E, Cepas-Guillen P, Regueiro A, Sanchis L, Unigarro F, Brugaletta S, et al. Treatment of device-related thrombosis after left atrial appendage occlusion: initial experience with low-dose apixaban. Cardiovasc Revasc Med. 2022;40:201–3. Dannenberg L, Mourikis P, Naguib D, Zako S, Helten C, M'Pembele R, et al. Antiplatelet effects of aspirin and clopidogrel after left atrial appendage (LAA) occluder implantation. Int J Cardiol. 2019;275:95–100. Aarnink EW, Huijboom MFM, Bor WL, Maarse M, Zheng KL, Ten Cate H, et al. Hemostatic biomarkers and antithrombotic strategy in percutaneous left atrial interventions: state-of-the-art review. Thromb Res. 2022;215:41–51. Article / Publication Details

First-Page Preview

Received: May 20, 2022
Accepted: October 08, 2022
Published online: December 13, 2022

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 1

ISSN: 0031-7012 (Print)
eISSN: 1423-0313 (Online)

For additional information: https://www.karger.com/PHA

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