Short-term non-vitamin K antagonist oral anticoagulants vs. warfarin in preventing device-related thrombosis after left atrial appendage closure.

ABSTRACT

Up to now we have had few evidences on the Non-vitamin K Antagonist Oral Anticoagulants (NOACs)' efficacy and safety in preventing device-related thrombosis (DRT) after percutaneous left atrial appendage closure (LAAC). After LAAC implantation, short-term anticoagulation (NOACs or warfarin) was prescribed. Baseline clinical characteristics, procedural parameters and postoperative follow up data were collected and compared between the two groups. From May 2014 to June 2018, 361 consecutive patients underwent LAAC implantation in our center. 170 patients received warfarin for 45 days at least after LAAC implantation, who were compared with 170 age-matched patients on NOACs. The basic clinical characteristics, as well as procedural parameters were comparable between the two groups, while the NOACs group had higher average CHA2DS2-VASc score (3.3  ±  1.6 vs. 2.9  ±  1.5, P = 0.022*). At 45 days follow up, 289 (86.5%) patients received transoesophageal echocardiography (TEE), and the overall incidence of DRT was 2.4%. The DRT rate was not significantly different between the NOACs and warfarin groups (2.7% vs. 2.1%, P > 0.05), while the NOACs group showed lower all bleeding rate (1.2% vs. 9.0%, P < 0.01). The rates of ischemic stroke as well as major bleeding were comparable between the two groups. Except for 7 DRTs and 1 major peri-device leakage (> 5 mm), anticoagulation was terminated in all other patients. During the follow-up thereafter (mean 868 days), the rates of all-cause death, ischemic stroke and bleeding were comparable between the two groups. Short-term NOACs after LAAC appear to be as effective as warfarin in preventing DRT, with lower bleeding rate.