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Light anti-thrombotic regimen for prevention of device thrombosis and/or thrombotic complications after interatrial shunts device-based closure

Published:January 02, 2020DOI:https://doi.org/10.1016/j.ejim.2019.12.010

      Highlights

      • Antiplatelet therapy after the percutaneous closure of ASD/PFO effective.
      • ASA after percutaneous ASD/PFO closure was related to low rates of bleeding events.
      • ASA ensures a low incidence of device thrombosis and/or thrombotic events.

      Abstract

      Aims

      The optimal antiplatelet therapy after atrial septal defect (ASD) or patent foramen ovale device closure (PFO) remain to be established. We evaluated the safety and effectiveness of 6-month 100 mg Aspirin (ASA) regimen in the very long-term follow up after intracardiac echocardiography (ICE) –aided interatrial shunt closure in a large retrospective cohort.

      Methods

      Single-center retrospective analysis which included medical and instrumental data of 789 consecutive patients referred to our institution over a 15 years period due interatrial shunt catheter-based closure.

      Results

      Finally, 734 patients were included in the analysis (mean age 46.1 ± 14.6 years, 398 females): ASD and PFO closure were successfully performed in 281 and 453 patients, respectively. Over the follow-up period, no major bleeding events were observed while the rate of minor bleeding events was 0.9%. Tolerance problems were detected in 3.4% of cases (n==28). In 11 patients (1.5%) an abnormal complete blood count was detected and monitored up to normalization. On a mean follow –up of 10.3 ± 3.0 years (range 1–15), 10 patients (1.36%) had a persistent moderate shunt 12 months after closure and maintained Aspirin 100 mg life-long, whereas the remaining 724 suspended the treatment after 6 months. Device thrombosis in ASD and PFO groups were 0% and 0.2%, respectively. A cerebral ischemic event occurred in 0.4% of the entire cohort.

      Conclusions

      A regimen of 100 mg of ASA for six months after ASD/PFO closure appeared to be both safe and effective in preventing device thrombosis and major bleedings.

      Keywords

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      Linked Article

      • Light anti-thrombotic regimen after interatrial shunt device closure: A strategy for all patients?
        European Journal of Internal MedicineVol. 74
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          During the recent years, catheter-based closure of atrial septal defect (ASD) or patent foramen ovale (PFO) has become an effective and safe therapy for the curative treatment of patients with hemodynamically significant inter-atrial shunts [1]. Patients receiving this therapy present a peri-procedural risk of symptomatic thrombo-embolism of 1% to 2% [2] which raises to higher figures for asymptomatic episodes [3] and appears to be independent of the closure device used. In these patients, thrombus formation occurs more commonly in the setting of the procedure (through the delivery sheath or within the closure device).
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