Abstract：
Currently, no consensus has been established on the most effective antithrombotic therapy to prevent thromboembolic and bleeding events in patients undergoing percutaneous left atrial appendage closure (LAAC) with preprocedural thromboembolic or bleeding events under oral anticoagulation (OAC) therapy. We retrospectively investigated the incidence of device-related thrombosis (DRT), thromboembolic events, and bleeding events in patients who underwent LAAC from September 2019 to October 2022. After categorizing patients into three groups based on preprocedural thromboembolic or bleeding events under OAC therapy, we compared the incidence of DRT and prognosis according to the postprocedural antithrombotic therapy. In patients who received the conventional antithrombotic therapy (OAC with and without single antiplatelet therapy for 45 days after LAAC and dual-antiplatelet therapy from 45 days to 6 months followed by single antiplatelet therapy), preprocedural thromboembolic events despite OAC were independently associated with DRT or postprocedural thromboembolic events at the 3 year follow-up (hazard ratio [HR] 4.55; 95% confidence interval [CI] 1.32-15.6; P = 0.016), whereas preprocedural bleeding events were independently associated with postprocedural bleeding events (HR 8.01, 95% CI 1.45-58.3; P = 0.036). Continuation of OAC for 12 months among patients who developed preprocedural thromboembolic events during OAC significantly decreased the incidence of DRT or postoperative thromboembolic events (P = 0.002) with no increase in the bleeding events (P = 0.522). Preprocedural thromboembolic and bleeding events can predict adverse events after LAAC with the conventional antiplatelet-based antithrombotic therapy. Patients who develop thromboembolic events under continuous OAC may benefit from continuous OAC for 1 year after LAAC.
摘要：
目前,对于接受经皮左心耳封堵术(LAAC)并在口服抗凝(OAC)治疗下发生术前血栓栓塞或出血事件的患者,目前尚未就预防血栓栓塞和出血事件的最有效抗血栓治疗达成共识.我们回顾性调查了装置相关血栓形成（DRT）的发生率，血栓栓塞事件,以及2019年9月至2022年10月接受LAAC的患者的出血事件.根据术前血栓栓塞或OAC治疗下出血事件将患者分为三组,我们根据术后抗血栓治疗比较了DRT的发生率和预后.在接受常规抗血栓治疗的患者中（LAAC后45天有或没有单一抗血小板治疗，45天至6个月有双重抗血小板治疗，然后是单一抗血小板治疗），3年随访时，术前血栓栓塞事件与DRT或术后血栓栓塞事件独立相关(风险比[HR]4.55;95%置信区间[CI]1.32-15.6;P=0.016)，术前出血事件与术后出血事件独立相关(HR8.01,95%CI1.45-58.3;P=0.036).在OAC期间发生术前血栓栓塞事件的患者中，继续OAC治疗12个月显著降低了DRT或术后血栓栓塞事件的发生率（P=0.002），而出血事件没有增加（P=0.522）。术前血栓栓塞和出血事件可以预测常规抗血小板抗栓治疗后LAAC的不良事件。在连续OAC下发生血栓栓塞事件的患者可在LAAC后1年内受益于连续OAC。
