The Use of Novel Non-Vitamin K Antagonist Oral Anticoagulants Following Closure of the Left Atrial Appendage: Preliminary Results of Clinical Follow-Up

OBJECTIVE: The aim of this study was to investigate the safety and efficacy of using novel non-vitamin K antagonist oral anticoagulants (NOACs) for anticoagulation following left atrial appendage closure (LAAC). METHODS: A total of 70 patients with non-valvular atrial fibrillation (NVAF) were enrolled in this study. All patients underwent successful LAAC between November 2018 and September 2019 in the Department of Cardiology of the First Affiliated Hospital of the University of Science and Technology of China. All patients subsequently completed a 45-day postoperative follow-up period. Patients were grouped according to the postoperative anticoagulation regimen they received: there were 40 patients in the NOACs group and 30 patients in the warfarin group. Baseline clinical data, intraoperative data, and short-term postoperative follow-up data were collected and the two groups were compared. RESULTS: The intraoperative results showed no statistical difference between the two groups in respect of the occlusion rate, the compression ratio of the occluder, the volume of pericardial effusion, or the incidence of the following: residual shunts, device-related thromboses (DRT), stroke, and pericardial effusion (P > 0.05 in all cases). The residual shunt volume in the NOACs group was significantly smaller than that in the warfarin group (P = 0.04). During the 45-day postoperative follow-up period, there was no statistical difference between the two groups in respect of the residual shunt volume, or the incidence of DRT, ischemic stroke and cerebral hemorrhage (P > 0.05 in all cases). Compared with the warfarin group, the residual shunt volume was significantly reduced in the NOACs group (P = 0.03). The incidence of minor hemorrhage and the total hemorrhage incidence in the NOACs group were significantly lower than those in the warfarin group (5% vs 30%, P = 0.004, and 5% vs 33.3%, P = 0.002, respectively). CONCLUSION: In this study, the use of NOACs for postoperative anticoagulation therapy following LAAC did not increase the risk of embolization or hemorrhage during the short-term follow-up period.