Abstract
2/2020
vol. 16
Letter to the Editor
Response to Letter to the Editor “Adverse outcomes in anticoagulated patients undergoing percutaneous left atrial appendage ligation” by Anetta Undas
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- The Kansas City Heart Rhythm Institute, Overland Park Regional Hospital, University of Kansas, Kansas, USA
Adv Interv Cardiol 2020; 16, 2 (60): 233–234
Online publish date: 2020/06/23
We thank Prof. Undas for her interest in our recent article and comments on left atrial appendage occlusion [1]. We agree that our study indirectly points to potential benefits of non-vitamin K oral anticoagulants’ (NOAC) use in selected atrial fibrillation (AF) patients following left atrial appendage occlusion (LAAO) in the setting of high thromboembolic and bleeding risk, but a dedicated study is urgently needed to support this concept. Several points need to be discussed.
We presented the real-life observational data on different anticoagulation strategies in atrial fibrillation (AF) patients after LAAO using the LARIAT system between 2009 and 2015 [1]. During this period, the guidelines on oral anticoagulation in AF shifted towards the novel drugs. NOACs were approved in adults with non-valvular AF at the end of 2011, and 18% of patients studied by us received drugs from this group at the end of the study (2015). We observed a progressive increase in NOAC use starting from 2012–2013, which is in concordance with other Polish data [2]. The fraction of patients receiving NOACs is rather small, which may be a result of the relative unfamiliarity of LAAO procedure concepts, and/or reluctance to use drugs new to the market.
Unfortunately, detailed data on the quality of anticoagulation were unavailable in the current report, but poor quality of anticoagulant therapy is a well-known problem in AF patients. In Poland, the time within the therapeutic range (TTR) in primary care patients on vitamin K antagonist (VKA) therapy is around 55% [3], and some of the observed adverse events may, arguably, be caused by poor VKA anticoagulation management. Two hemorrhagic strokes were observed in non-anticoagulated patients and were probably caused by uncontrolled hypertension. The first of those patients, with a CHA2DS2-VASc score of 6 points and a HAS-BLED score of 3 points, was managed with aspirin. In the second patient, with a CHA2DS2-VASc score of 2 points and a HAS-BLED score of 2 points, no anticoagulation or antiplatelet drugs were given. In the OAC group a hemorrhagic stroke occurred in 1 patient on VKA, with a CHA2DS2-VASc score of 2 points and a HAS-BLED score of 3 points, who had INR > 3.5 (after this event, anticoagulation was discontinued completely). There was also one case of gastrointestinal bleeding in a NOAC-treated patient with a CHA2DS2-VASc score of 6 points and a HAS-BLED score of 5 points (the dose of dabigatran was reduced after...
Pełna treść artykułu...
We presented the real-life observational data on different anticoagulation strategies in atrial fibrillation (AF) patients after LAAO using the LARIAT system between 2009 and 2015 [1]. During this period, the guidelines on oral anticoagulation in AF shifted towards the novel drugs. NOACs were approved in adults with non-valvular AF at the end of 2011, and 18% of patients studied by us received drugs from this group at the end of the study (2015). We observed a progressive increase in NOAC use starting from 2012–2013, which is in concordance with other Polish data [2]. The fraction of patients receiving NOACs is rather small, which may be a result of the relative unfamiliarity of LAAO procedure concepts, and/or reluctance to use drugs new to the market.
Unfortunately, detailed data on the quality of anticoagulation were unavailable in the current report, but poor quality of anticoagulant therapy is a well-known problem in AF patients. In Poland, the time within the therapeutic range (TTR) in primary care patients on vitamin K antagonist (VKA) therapy is around 55% [3], and some of the observed adverse events may, arguably, be caused by poor VKA anticoagulation management. Two hemorrhagic strokes were observed in non-anticoagulated patients and were probably caused by uncontrolled hypertension. The first of those patients, with a CHA2DS2-VASc score of 6 points and a HAS-BLED score of 3 points, was managed with aspirin. In the second patient, with a CHA2DS2-VASc score of 2 points and a HAS-BLED score of 2 points, no anticoagulation or antiplatelet drugs were given. In the OAC group a hemorrhagic stroke occurred in 1 patient on VKA, with a CHA2DS2-VASc score of 2 points and a HAS-BLED score of 3 points, who had INR > 3.5 (after this event, anticoagulation was discontinued completely). There was also one case of gastrointestinal bleeding in a NOAC-treated patient with a CHA2DS2-VASc score of 6 points and a HAS-BLED score of 5 points (the dose of dabigatran was reduced after...
Pełna treść artykułu...
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