Clinical outcomes of left atrial appendage closure and post-operative antiplatelet therapy in patients with contraindication to anticoagulation: a systematic review

• Autor(a) principal: Catarina de Vasconcelos Peixoto Fonseca
• Data de Publicação: 2020
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://hdl.handle.net/10216/128663
• topic: Medicina clínica; Clinical medicine

Background Randomized clinical trials have been performed to analyzed the efficacy and safety of left atrial appendage closure in nonvalvular atrial fibrillation versus medical management. This technique had emerged for patients with contraindication to anticoagulation therapy; nonetheless, those patients were still medicated with anticoagulation strategies for a period of time, which gave rise to safety concerns. Our systematic review aims to evaluate the feasibility of this intervention in patients with contraindication to anticoagulation and post-operative antiplatelet therapy. Methods A comprehensive search of the Medline and ISI Web of Knowledge databases was conducted using pre-defined criteria. We included non-comparative cohort studies with at least 15 patients and a follow-up time longer than 6 months. Results We selected 21 eligible studies enrolling 3974 patients. The adjusted pooled incidence rate of thromboembolic events was 1.99/100 person-years (95% CI: 1.66 to 2.38/100 person-years) and the incidence rate of major bleeding corresponded to 2.07/100 person-years (95% CI: 1.40 to 3.06/100 person-years). These results were similar, if not better, that the outcomes of the clinical trials made so far. The incidence rate of all-cause mortality was 6.13 per 100 person-years (95% CI: 5.18 to 7.27 person-years), with a higher proportion of mortality associated to non-cardiovascular causes. Among patients that changed from antiplatelet therapy to anticoagulation, the incidence rate was 1.62/100 person-years (95% CI: 0.92 to 2.84 person-years). Conclusions Our review sustains the feasibility of this technique in patients submitted to antiplatelet therapy, on the prevention of thromboembolic and bleeding events, in comparison to anticoagulation after procedure.