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Impact of gender in patients with device-related thrombosis after left atrial appendage closure -- a sub-analysis from the multicenter EUROC-DRT-registry
  • +45
  • 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
Jacqueline Saw
Vancouver General Hospital
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Vivian Vij
Herzzentrum des Universitatsklinikums Bonn
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Roberto Galea
Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie
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Kerstin Piayda
Centrum fur Kardiologie und Angiologie
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Dominik Nelles
Herzzentrum des Universitatsklinikums Bonn
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Lara Vogt
Herzzentrum des Universitatsklinikums Bonn
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Steffen Gloekler
Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie
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Monika Fürholz
Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie
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Bernhard Meier
Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie
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Lorenz Räber
Inselspital Universitatsspital Bern Universitatsklinik fur Kardiologie
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Gilles O'Hara
Universite Laval Faculte de Medecine
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Dabit Arzamendi
Hospital de la Santa Creu i Sant Pau
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Victor Agudelo
Hospital de la Santa Creu i Sant Pau
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Lluis Asmarats
Universite Laval Faculte de Medecine
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Xavier Freixa
Hospital Clinic de Barcelona
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Eduardo J Flores-Umanzor
Hospital Clinic de Barcelona
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Ole De Backer
Rigshospitalet
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Lars Sondergaard
Rigshospitalet
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Luis Nombela Franco
Hospital Clinico San Carlos Servicio de Cardiologia
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Pablo Salinas
Hospital Clinico San Carlos Servicio de Cardiologia
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Kasper Korsholm
Aarhus Universitetshospital
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Jens Erik Nielsen-Kudsk
Aarhus Universitetshospital
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Tobias Zeus
Universitatsklinikum Dusseldorf
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Felix Operhalski
Bethanien-Krankenhaus
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Boris Schmidt
Bethanien-Krankenhaus
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Gilles Montalescot
Hopital Universitaire Pitie-Salpetriere
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Paul Guedeney
Hopital Universitaire Pitie-Salpetriere
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Xavier Iriart
Centre Hospitalier Universitaire de Bordeaux Hopital Cardiologique
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Noelie Miton
Centre Hospitalier Universitaire de Bordeaux Hopital Cardiologique
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Thomas Gilhofer
UniversitatsSpital Zurich
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Laurent Fauchier
Centre Hospitalier Regional Universitaire de Tours
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Egzon Veliqi
Asklepios Klinik Sankt Georg
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Felix Meincke
Asklepios Klinik Sankt Georg
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Nils Petri
Universitatsklinikum Wurzburg
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Peter Nordbeck
Universitatsklinikum Wurzburg
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Rocio Gonzalez-Ferreiro
Hospital Clinico de Salamanca
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Ignacio Cruz-González
Hospital Clinico de Salamanca
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Deepak Bhatt L
Icahn School of Medicine at Mount Sinai
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Alessandra Laricchia
IRCCS Humanitas Research Hospital
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Antonio Mangieri
IRCCS Humanitas Research Hospital
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Heyder Omran
GFO Kliniken Bonn Betriebsstatte St Marien
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Jan Wilko Schrickel
Herzzentrum des Universitatsklinikums Bonn
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Thomas Beiert
Herzzentrum des Universitatsklinikums Bonn
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Josep Rodes-Cabau
Universite Laval Faculte de Medecine
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Georg Nickenig
Herzzentrum des Universitatsklinikums Bonn
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Horst Sievert
Centrum fur Kardiologie und Angiologie
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Alexander Sedaghat
Herzzentrum des Universitatsklinikums Bonn

Corresponding Author:alexander.sedaghat@ukbonn.de

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Shazia Afzal
Krankenhaus der Barmherzigen Bruder Trier
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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.
Submitted to Echocardiography
22 Apr 2024Submission Checks Completed
22 Apr 2024Assigned to Editor
22 Apr 2024Review(s) Completed, Editorial Evaluation Pending
22 Apr 2024Reviewer(s) Assigned
21 Jun 20241st Revision Received
24 Jun 2024Submission Checks Completed
24 Jun 2024Assigned to Editor
24 Jun 2024Review(s) Completed, Editorial Evaluation Pending
24 Jun 2024Reviewer(s) Assigned
29 Jun 2024Editorial Decision: Accept