2. Ospedale San Raffaele, cardiology, Milan, Italy
3. Interventional Cardiovascular Unit, San Raffaele Hospital, Milan
4. Arrhythmia and Electrophysiology Unit, San Raffaele Hospital, Milan
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Methods and results: All consecutive patients who underwent successful LAAO (n=193) and those treated with NOACs (n=189) (dabigatran, apixaban or rivaroxaban) were included. A 1:1 propensity-score-matching (PSM) was used to match LAAO and NOACs patients. At baseline, patients in the LAAO group had higher HAS-BLED (4.2% vs 3.3%, p<0.001) and lower CHADS-VASc (4.3% vs. 4.7%, p=0.005). After 1:1 PSM, 192 patients were enrolled in the final analysis (LAAO n=96; NOACs n=96). At 2-year follow-up, no significant difference in thromboembolic (7.3% vs. 6.3%, p=0.966) and ISTH-major bleeding events rate (6.7% vs. 4.8% p=0.503) were found between the two unmatched groups. All-cause death was significantly higher in the LAAO group (18.7% vs. 10.6%; p=0.049). After PSM, all-cause death, thromboembolic and ISTH-major bleeding event rates were similar between groups. Significant independent predictors of all-cause death were dialysis (HR 5.65, 2.16-14.85, p<0.001) and age (HR 1.08, 95% CI 1.05-1.13, p<0.001).
Conclusions: In NVAF patients at HBR, LAAO and NOACs performed similarly in terms of thromboembolic and major bleeding events up to 2-year follow-up. Our findings warrant further investigations in randomized trials and therefore can be considered as hypothesis generating.
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