Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network meta-analysis
Background: Percutaneous left atrial appendage occlusion (LAAO) has emerged as a stroke prevention strategy in patients with nonvalvular atrial fibrillation (NVAF), and these patients were required to receive antithrombotic therapy post-procedure. However, the optimal antithrombotic strategy after L...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2023.1159857/full |
| _version_ | 1797729301641035776 |
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| author | Li-Man Wang Li-Man Wang Yan Chen Yan Chen Li-Li Xu Li-Li Xu Meng-Fei Dai Meng-Fei Dai Yi-Jun Ke Bao-Yan Wang Lin Zhou Ji-Fan Zhang Zhang-Qi Wu Yu-Jie Zhou Zhi-Chun Gu Hang Xu |
| author_facet | Li-Man Wang Li-Man Wang Yan Chen Yan Chen Li-Li Xu Li-Li Xu Meng-Fei Dai Meng-Fei Dai Yi-Jun Ke Bao-Yan Wang Lin Zhou Ji-Fan Zhang Zhang-Qi Wu Yu-Jie Zhou Zhi-Chun Gu Hang Xu |
| author_sort | Li-Man Wang |
| collection | DOAJ |
| description | Background: Percutaneous left atrial appendage occlusion (LAAO) has emerged as a stroke prevention strategy in patients with nonvalvular atrial fibrillation (NVAF), and these patients were required to receive antithrombotic therapy post-procedure. However, the optimal antithrombotic strategy after LAAO remains controversial. This study explored the safety and efficacy of different antithrombotic strategies after LAAO through a network comparison method.Methods: We systematically searched the MEDLINE, Embase, and Cochrane Library databases for studies that reported the interested efficacy and safety outcomes (stroke, device-related thrombus (DRT), and major bleeding) of different antithrombotic strategies [DAPT (dual antiplatelet therapy), DOACs (direct oral anticoagulants), and VKA (vitamin k antagonist)] in patients who had experienced LAAO. Pairwise comparisons and network meta-analysis were performed for the interested outcomes. Risk ratios (RRs) with their confidence intervals (CIs) were calculated using a random-effects model. The rank of the different strategies was calculated using the surface under the cumulative ranking curve (SUCRA).Results: Finally, 10 observational studies involving 1,674 patients were included. There was no significant difference in stroke, DRT, and major bleeding among the different antithrombotic strategies (DAPT, DOACs, and VKA). Furthermore, DAPT ranked the worst in terms of stroke (SUCRA: 19.8%), DRT (SUCRA: 3.6%), and major bleeding (SUCRA: 6.6%). VKA appeared to be superior to DOACs in terms of stroke (SUCRA: 74.9% vs. 55.3%) and DRT (SUCRA: 82.3% vs. 64.1%) while being slightly inferior to DOACs in terms of major bleeding (SUCRA: 71.0% vs. 72.4%).Conclusion: No significant difference was found among patients receiving DAPT, DOACs, and VKA in terms of stroke, DRT, and major bleeding events after LAAO. The SUCRA indicated that DAPT was ranked the worst among all antithrombotic strategies due to the higher risk of stroke, DRT, and major bleeding events, while VKAs were ranked the preferred antithrombotic strategy. However, DOACs are worthy of consideration due to their advantage of convenience. |
| first_indexed | 2024-03-12T11:27:12Z |
| format | Article |
| id | doaj.art-6681303c5d734aefb4ae0a7a2e66408c |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-03-12T11:27:12Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-6681303c5d734aefb4ae0a7a2e66408c2023-09-01T07:06:23ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122023-09-011410.3389/fphar.2023.11598571159857Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network meta-analysisLi-Man Wang0Li-Man Wang1Yan Chen2Yan Chen3Li-Li Xu4Li-Li Xu5Meng-Fei Dai6Meng-Fei Dai7Yi-Jun Ke8Bao-Yan Wang9Lin Zhou10Ji-Fan Zhang11Zhang-Qi Wu12Yu-Jie Zhou13Zhi-Chun Gu14Hang Xu15Department of Pharmacy, China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, ChinaSchool of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaDepartment of Pharmacy, China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, ChinaSchool of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaDepartment of Pharmacy, China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, ChinaSchool of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaDepartment of Pharmacy, China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, ChinaSchool of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaDepartment of Pharmacy, Anqing Municipal Hospital, Affiliated with Anhui Medical University, Anqing, ChinaDepartment of Pharmacy, China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, ChinaDepartment of Pharmacy, China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, ChinaNanjing Foreign Language School, Nanjing, ChinaNanjing Jinling High School International Department, Nanjing, ChinaDepartment of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, ChinaDepartment of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Pharmacy, China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, ChinaBackground: Percutaneous left atrial appendage occlusion (LAAO) has emerged as a stroke prevention strategy in patients with nonvalvular atrial fibrillation (NVAF), and these patients were required to receive antithrombotic therapy post-procedure. However, the optimal antithrombotic strategy after LAAO remains controversial. This study explored the safety and efficacy of different antithrombotic strategies after LAAO through a network comparison method.Methods: We systematically searched the MEDLINE, Embase, and Cochrane Library databases for studies that reported the interested efficacy and safety outcomes (stroke, device-related thrombus (DRT), and major bleeding) of different antithrombotic strategies [DAPT (dual antiplatelet therapy), DOACs (direct oral anticoagulants), and VKA (vitamin k antagonist)] in patients who had experienced LAAO. Pairwise comparisons and network meta-analysis were performed for the interested outcomes. Risk ratios (RRs) with their confidence intervals (CIs) were calculated using a random-effects model. The rank of the different strategies was calculated using the surface under the cumulative ranking curve (SUCRA).Results: Finally, 10 observational studies involving 1,674 patients were included. There was no significant difference in stroke, DRT, and major bleeding among the different antithrombotic strategies (DAPT, DOACs, and VKA). Furthermore, DAPT ranked the worst in terms of stroke (SUCRA: 19.8%), DRT (SUCRA: 3.6%), and major bleeding (SUCRA: 6.6%). VKA appeared to be superior to DOACs in terms of stroke (SUCRA: 74.9% vs. 55.3%) and DRT (SUCRA: 82.3% vs. 64.1%) while being slightly inferior to DOACs in terms of major bleeding (SUCRA: 71.0% vs. 72.4%).Conclusion: No significant difference was found among patients receiving DAPT, DOACs, and VKA in terms of stroke, DRT, and major bleeding events after LAAO. The SUCRA indicated that DAPT was ranked the worst among all antithrombotic strategies due to the higher risk of stroke, DRT, and major bleeding events, while VKAs were ranked the preferred antithrombotic strategy. However, DOACs are worthy of consideration due to their advantage of convenience.https://www.frontiersin.org/articles/10.3389/fphar.2023.1159857/fullleft atrial appendage occlusionnetwork meta-analysiswarfarindual antiplatelet therapydirect oral anticoagulants |
| spellingShingle | Li-Man Wang Li-Man Wang Yan Chen Yan Chen Li-Li Xu Li-Li Xu Meng-Fei Dai Meng-Fei Dai Yi-Jun Ke Bao-Yan Wang Lin Zhou Ji-Fan Zhang Zhang-Qi Wu Yu-Jie Zhou Zhi-Chun Gu Hang Xu Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network meta-analysis Frontiers in Pharmacology left atrial appendage occlusion network meta-analysis warfarin dual antiplatelet therapy direct oral anticoagulants |
| title | Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network meta-analysis |
| title_full | Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network meta-analysis |
| title_fullStr | Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network meta-analysis |
| title_full_unstemmed | Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network meta-analysis |
| title_short | Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network meta-analysis |
| title_sort | short term antithrombotic strategies after left atrial appendage occlusion a systematic review and network meta analysis |
| topic | left atrial appendage occlusion network meta-analysis warfarin dual antiplatelet therapy direct oral anticoagulants |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2023.1159857/full |
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