Direct oral anticoagulants versus left atrial appendage closure in elderly patients (>80) with atrial fibrillation: results from a propensity matched analysis in real-life patients
Bibliographic record
Abstract
Abstract Introduction Information comparing left atrial appendage closure (LAAC) to direct oral anticoagulation therapy (DOAC) is scarce. Purpose Our aim is to compare the clinical outcomes between LAAC and DOACs of an elderly population (over 80 years-old). Methods We retrospectively collected 1144 patients with atrial fibrillation over 80 years old from three different tertiary hospitals. 970 patients have received DOACs and 174 patients have undergone LAAC. We have performed a propensity score matching analysis (PSM), with a caliper of 0.2. After propensity score with matching analysis, 58 patients received DOACs alone and 58 patients treated with LAAC with similar baseline risk factors, comorbidities and risk scores were selected. Outcomes of DOACs and LAAC were assessed by Cox regression. Results Both groups had similar cardiovascular risk factors with more proportion of diabetic and hypertensive patients among LAAC group (37.4% and 90.2%, respectively vs 20.3% and 70.3%). Patients undergoing LAAC had more frequently history of bleeding, anemia or previous cancer. CHA2DS2VASC score was also significantly higher in these patients. During a median follow-up of 2.0 years (range 0.9–3.5) event rate for the combined endpoint of death, bleeding and embolic events was 24.9%. 81 embolic events were recorded (27 patients had transient ischemic attacks and 52 were diagnosed of stroke and only 2 patients with pulmonary embolism and 2 more with peripheral embolic events). 131 bleedings were recorded with 1,5% of intracranial bleeding. After propensity score matching, no differences regarding the primary composite endpoint were found (HR 1.05, 95% CI 0.15–7.51; p=0.955). Bleeding events were more frequent in LAAC group, especially during the first three months, thereafter rates become similar in both groups with no statistically significant differences (HR 1.79, 95% CI 0.73–4.41; p=0.205) (Figure 1). We calculate the time to first bleeding for LAAC 0.9±1.3 vs 1.7±1.3 on DOACs. Mortality was numerically greater in patients on DOACs (31,8%) vs LAAC (26,4%). However, this finding did not reach statistical significance (HR 0.70, 95% CI 0.33–1.47; p=0.343). Conclusions LAAC has no differences in terms of embolic events, bleeding events and mortality compared to DOACS in a population of elderly patients over 80 years-old. In our population, LAAC is a strategy as safe and effective as DOACs and represents an alternative to consider in real life patients older than 80 years. Figure 1 Funding Acknowledgement Type of funding source: None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".