Medication regimens confer similar short-term outcomes after LAA closure for AF
After left atrial appendage occlusion with a next-generation device, patients with atrial fibrillation had similar outcomes at 45 days regardless of medication regimen, researchers reported at TVT: The Structural Heart Summit.
From a database of patients who underwent left atrial appendage (LAA) occlusion with the next-generation device (Watchman FLX, Boston Scientific) and were included in the National Cardiovascular Disease LAAO Registry, the researchers propensity score-matched 4,244 patients who were discharged on dual antiplatelet therapy or a direct oral anticoagulant (DOAC) plus aspirin, and propensity score-matched 2,814 patients who were discharged on DAPT or warfarin plus aspirin. The current FDA indication for the device calls for 45 days of anticoagulation plus aspirin after the procedure to reduce risk for device-related thrombus and stroke.
“The medications prescribed to patients after LAAO is already highly variable around the world, even though the current FDA approval is for an aspirin and an anticoagulant,” Megan Coylewright, MD, MPH, FACC, FSCAI, vice chief of cardiology faculty development and director of the health system’s Structural Heart Program at Erlanger Health System in Tennessee, said during a presentation. “We examined data on safety and efficacy of dual antiplatelet therapy compared to this regimen.”
The mean age of the study population was 77 years; percentage of women varied from 39% to 42% depending on regimen.
In the analysis of DAPT vs. DOAC plus aspirin, there was no difference at 45 days between the groups in the composite endpoint of death, stroke or major bleeding (DAPT, 2.9%; DOAC/aspirin, 3.3%; P = .48), death (DAPT, 0.7%; DOAC/aspirin, 0.8%; P = .6), stroke (DAPT, 0.2%; DOAC/aspirin, 0.1%; P = .29), major bleeding (DAPT, 2.2%; DOAC/aspirin, 2.5%; P = .48) and device-related thrombus (DAPT, 0.1%; DOAC/aspirin, 0%; P = .62), Coylewright said.
In the analysis of DAPT vs. warfarin plus aspirin, there was no difference in the 45-day outcomes (composite endpoint: DAPT, 2.8%; warfarin/aspirin, 3%; P = .82; death: DAPT, 0.5%; warfarin/aspirin, 0.8%; P = .34; stroke: DAPT, 0.3%; warfarin/aspirin, 0.1%; P > .99; major bleeding: DAPT, 2.3%; warfarin/aspirin, 2.2%; P = .9; device-related thrombus: DAPT, 0.1%; warfarin/aspirin, 0%; P = .5), according to the researchers.
“There was no difference in death, stroke, bleeding or device-related thrombosis between DAPT and DOAC plus aspirin or warfarin plus aspirin at 45 days following LAA occlusion with Watchman FLX,” Coylewright said during the presentation. “Great variability already exists in medication selection in the LAAO Registry. Patient engagement remains essential when selecting postprocedure medications for LAAO.”
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Coylewright M, et al. Featured Clinical Research. Presented at: TVT: The Structural Heart Summit; June 8-10, 2022; Chicago (hybrid meeting).
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