Author + information
- Received July 8, 2019
- Revision received November 7, 2019
- Accepted November 14, 2019
- Published online May 18, 2020.
- Mohammed Osman, MDa,
- Tatiana Busu, MDa,
- Khansa Osman, MDb,
- Safi U. Khan, MDa,
- Matthew Daniels, MDc,
- David R. Holmes, MDd and
- Mohamad Alkhouli, MDd,∗ (, )@adnanalkhouli
- aDivision of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
- bMichigan Health Specialist, Michigan State University, Flint, Michigan
- cDivision of Cardiovascular Medicine, Department of Medicine, University of Oxford, Oxford, United Kingdom
- dDepartment of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Mohamad Alkhouli, Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, 200 First Street Southwest, Rochester, Minnesota 55905.
Objectives The aim of this study was to compare bleeding, thromboembolic, device-related thrombus (DRT), and all-cause mortality events between patients treated with short-term oral anticoagulation (OAC) and those treated with short-term antiplatelet therapy (APT) following left atrial appendage occlusion (LAAO).
Background Short-term OAC is recommended for patients following LAAO. However, in practice many patients receive APT rather than OAC because of excessive bleeding risk. However, the safety and efficacy of APT compared with OAC have been debated.
Methods A search was conducted of databases for studies comparing OAC with APT following LAAO. The outcomes of interest were all-cause stroke, major bleeding, DRT, and all-cause mortality. Noncomparative studies were pooled into a single study to generate comparisons of the studies’ outcomes. Effects measure were pooled using the random-effect model.
Results A total of 83 studies with 12,326 patients (APT, n = 7,900; OAC, n = 4,151) were included. Mean CHA2DS2-VASc and HAS-BLED scores were 4.1 ± 1.6 and 3.0 ± 1.3, respectively. There were no significance differences between the APT and OAC groups with regard to stroke (risk ratio [RR]: 1.04; 95% confidence interval [CI]: 0.54 to 1.98; p = 0.91; I2 = 31%), major bleeding (RR: 1.12; 95% CI: 0.68 to 1.84; p = 0.65; I2 = 53%), DRT (RR: 1.33; 95% CI: 0.74 to 2.39; p = 0.33; I2 = 36%), and all-cause mortality (RR: 1.29; 95% CI: 0.40 to 4.09; p = 0.18; I2 = 36%). These findings persisted in multiple secondary analyses: 1) excluding studies that reported no events; 2) including comparative studies only; 3) excluding patients who were treated with single APT; and 4) removing one study at a time to assess the effect of each study on the overall effect size. There was also no difference in the studies’ endpoints among patients who received different LAAO devices.
Conclusions In a meta-analysis of observational data, there were no differences in the occurrence of stroke, major bleeding DRT, and all-cause mortality in patients treated with short-term OAC or APT following LAAO.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received July 8, 2019.
- Revision received November 7, 2019.
- Accepted November 14, 2019.
- 2020 American College of Cardiology Foundation
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