Impact of gender in patients with device-related thrombosis after left atrial appendage closure -- a sub-analysis from the multicenter EUROC-DRT-registry
Year: 2024
Type: preprint
Abstract: Background Device-related thrombosis (DRT) is a common finding after left atrial appendage closure (LAAC) and is associated with worse outcomes. As women are underrepresented in clinical studies, further understanding of sex differences in DRT patients is warranted. Methods and Results This sub-analysis from the EUROC-DRT-registry compromises 176 patients with diagnosis of DRT after LAAC. Women, who accounted for 34.7% (61/176) of patients, were older (78.0±6.7 vs. 74.9±9.1 years, p=0.06) with lower rates of comorbidities. While DRT were detected significantly later in women (173±267 vs. 127±192 days, p=0.01), anticoagulation therapy was escalated similarly, mainly with initiation of novel oral anticoagulant (NOAC), vitamin K antagonist (VKA) or heparin. DRT resolution was achieved in 67.5% (27/40) of women and in 75.0% (54/72) of men (p=0.40). In the remaining cases, an intensification/switch of anticoagulation was conducted in 50% (9/18) of men and in 41.7% (5/12) of women. Final resolution was achieved in 72.5% (29/40) cases in women, and in 81.9% (59/72) cases in men (p=0.24). Women were followed-up for a similar time as men (779±520 vs. 908±687 days, p=0.51). Kaplan-Meier analysis revealed no difference in mortality rates in women (Hazard Ratio [HR]: 1.73, 95%-Confidence interval [95%-CI]: 0.68-4.37, p=0.25) and no differences in stroke (HR: 0.83, 95%-CI: 0.30-2.32, p=0.72) within two years after LAAC. Conclusion Evaluation of risk factors and outcome revealed no differences between men and women, with DRT in women being diagnosed significantly later. Women should be monitored closely to assess for DRT formation/resolution. Treatment strategies appear to be equally effective.
Authors: Jacqueline Saw, Vivian Vij, Roberto Galea, Kerstin Piayda, Dominik Nelles, Lara Vogt, Steffen Gloekler, Monika Fürholz, Bernhard Meier, Lorenz Räber, Gilles O'Hara, Dabit Arzamendi, Victor Agudelo, Lluis Asmarats, Xavier Freixa, Eduardo J Flores-Umanzor, Ole De Backer, Lars Sondergaard, Luis Nombela Franco, Pablo Salinas, Kasper Korsholm, Jens Erik Nielsen-Kudsk, Tobias Zeus, Felix Operhalski, Boris Schmidt, Gilles Montalescot, Paul Guedeney, Xavier Iriart, Noelie Miton, Thomas Gilhofer, Laurent Fauchier, Egzon Veliqi, Felix Meincke, Nils Petri, Peter Nordbeck, Rocio Gonzalez-Ferreiro, Ignacio Cruz-González, Deepak Bhatt L, Alessandra Laricchia, Antonio Mangieri, Heyder Omran, Jan Wilko Schrickel, Thomas Beiert, Josep Rodes-Cabau, Georg Nickenig, Horst Sievert, Alexander Sedaghat, Shazia Afzal
Institutions: Vancouver General Hospital, University Hospital Bonn, University Hospital of Bern, Université Laval, Hospital de Sant Pau, Hospital Clínic de Barcelona, Rigshospitalet, Hospital Clínico San Carlos, Aarhus University Hospital, Krankenhaus der Barmherzigen Brüder Trier, Düsseldorf University Hospital, Krankenhaus Bethanien, Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Université de Bordeaux, Centre Hospitalier Universitaire de Bordeaux, Electrophysiology and Heart Modeling Institute, University Hospital Zurich, Centre Hospitalier Universitaire de Tours, Asklepios Klinik St. Georg, Universitätsklinikum Würzburg, Complejo Hospitalario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Icahn School of Medicine at Mount Sinai, Humanitas University, IRCCS Humanitas Research Hospital, St. Marien-Hospital Bonn
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4399385686