Ahmed Ibrahim, Laila Shalabi, Sofian Zreigh, Shrouk Ramadan, Sohaila Mourad, Ghaith Eljadid, Mohammed Beshr, Ali Abdelaziz, Muhammed Elhadi, Pierre Sabouret, Mamas Mamas
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引用次数: 0
摘要
背景：对于有 OAT 禁忌症的非瓣膜性心房颤动（NVAF）患者，左心房阑尾封堵术（LAAO）是替代慢性口服抗凝药（OAT）预防卒中的一种方法。目的：本研究旨在比较LAAO术后小剂量直接口服抗凝药（DOACs）与双联抗血小板疗法（DAPT）的安全性和有效性：方法：2024 年 8 月对 PubMed、Scopus、Cochrane 和 Web of Science 进行了全面检索。方法：于 2024 年 8 月对 PubMededus、Scopus、Cochrane 和 Web Science 进行了全面检索，纳入了比较 LAAO 后低剂量 DOACs 和 DAPT 的研究。主要研究结果为复合疗效终点（DRT、脑卒中和全身性栓塞 [SE]），安全性终点为大出血事件。次要结果包括所有出血事件、全因死亡率以及疗效和安全性终点的复合结果：结果：共纳入四项研究，727 名患者。与 DAPT 相比，小剂量 DOACs 与较低的主要复合疗效终点发生率相关（OR = 0.36；95% CI [0.16，0.85]，P = 0.01）。在大出血事件方面未观察到明显差异（OR = 0.36；95% CI [0.11，1.18]；P = 0.091；I² = 0%）。与 DAPT 相比，低剂量 DOACs 也与较低的 DRT 事件发生率相关（OR = 0.36；95% CI [0.16，0.79]，p = 0.011）：结论：小剂量 DOACs 可有效减少 LAAO 后血栓栓塞事件，同时不会增加出血风险。这些研究结果支持将 DOACs 作为一种可行的 ATT 选择，但还需要更大规模的试验来确认最佳方案。
Comparative Efficacy and Safety of Low-Dose Direct Oral Anticoagulants Versus Dual Antiplatelet Therapy Following Left Atrial Appendage Occlusion in Patients With Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis.
Background: Left atrial appendage occlusion (LAAO) is an alternative to chronic oral anticoagulation (OAT) for stroke prevention in nonvalvular atrial fibrillation (NVAF) patients with contraindications to OAT. Postprocedure antithrombotic therapy (ATT) is essential to reduce the risk of device-related thrombosis (DRT), but the optimal regimen remains uncertain.
Aims: This study aims to compare the safety and efficacy of low-dose direct oral anticoagulants (DOACs) versus dual antiplatelet therapy (DAPT) following LAAO.
Methods: A comprehensive search of PubMed, Scopus, Cochrane, and Web of Science was conducted in August 2024. Studies comparing low-dose DOACs and DAPT post-LAAO were included. The primary outcomes were a composite efficacy endpoint (DRT, strokes, and systemic embolism [SE]) and major bleeding events as the safety endpoint. Secondary outcomes included all bleeding events, all-cause mortality, and a composite of efficacy and safety endpoints.
Results: Four studies with 727 patients were included. Low-dose DOACs were associated with lower rates of the primary composite efficacy endpoint compared to DAPT (OR = 0.36; 95% CI [0.16, 0.85], p = 0.01). No significant difference in major bleeding events was observed (OR = 0.36; 95% CI [0.11, 1.18]; p = 0.091; I² = 0%). Compared to DAPT, low-dose DOACs were also associated with lower rates of DRT events (OR = 0.36; 95% CI [0.16, 0.79], p = 0.011).
Conclusion: Low-dose DOACs effectively reduce thromboembolic events post-LAAO without increasing bleeding risk. These findings support their use as a viable ATT option, but larger trials are needed to confirm optimal regimens.
期刊介绍：
Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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