Impact of gender in patients with device-related thrombosis after left
atrial appendage closure -- a sub-analysis from the multicenter
EUROC-DRT-registry
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.