Despite the fact that antithrombotic therapy was indicated after left atrial appendage closure (LAAC), certain patients require termination of antithrombotic therapy after LAAC despite the lack of evidence for its safety. Researchers sought to see how patients fared after discontinuing antithrombotic therapy early following LAAC. It was multicenter research with 1,082 individuals who had a successful LAAC procedure. Early antithrombotic treatment was defined as stopping all antiplatelet/anticoagulant medications within 6 months of the operation. Patients with and without early antithrombotic therapy termination were compared using a propensity-matched approach. Antithrombotic therapy was discontinued early in 148 patients (13.7%). Antithrombotic medication discontinuation patients had a lower CHA2DS2-VASc score (p<0.001) and a higher rate of past gastrointestinal bleeding events (p=0.01) than patients who did not discontinue treatment. The incidences of death, ischemic stroke, and severe bleeding were 12.1, 0.6, and 3.3 per 100 patient-years following a median follow-up of 2.1 (1,1-3.1) years after antithrombotic medication termination. Antithrombotic treatment discontinuation patients had a similar risk of death (hazard ratio [HR] 1.06, 95% CI 0.65 to 1.71, p=0.82), ischemic stroke (HR 0.39, 95% CI 0.04 to 3.79, P=0.42), and major bleeding (HR 1.48, 95% CI 0.56 to 3.88, p=0.43) in 119 matched pairs with similar baseline characteristics. After a median follow-up of 2 years, antithrombotic treatment was discontinued in 1 of 7 patients within 6 months of LAAC, and this was not linked with an increased risk of mortality or thromboembolic events. Based on physician assessment, the data indicated the safety of shorter periods of antithrombotic medication after LAAC in high bleeding risk patients. More trials were required.
Source:www.ajconline.org/article/S0002-9149(22)00119-9/fulltext
