Abstract 12051: Anticoagulation Use After Percutaneous Left Atrial Appendage Occlusion in Medicare Beneficiaries

Background: In the pivotal trials of percutaneous left atrial appendage occlusion (pLAAO), patients received warfarin for 45 days followed by dual antiplatelets up to 6 months post pLAAO; however, real-world use of anticoagulants post pLAAO implantation is unknown. Objectives: To assess prescription anticoagulation and antiplatelet use after pLAAO in Medicare beneficiaries. Methods: We used a 15% sample of Medicare claims data (2015-2018) to identify patients who received pLAAO. Prescriptions claims were used to assess anticoagulant and antiplatelet use (other than over the counter aspirin) up to 12 months post pLAAO. Results: A total of 2,780 patients were included. The mean CHA2DS2-VASc score was 4.9. There were 2,171 (78.1%) patients who were prescribed anticoagulants after pLAAO. The most common drug was warfarin (63.8% of total anticoagulants used), followed by apixaban in 23.2% of the patients. At 3 months, 54.3% of the patients were taking a potent antithrombotic (anticoagulant or a P2Y12 inhibitor) medication. The number of patients taking potent antithrombotics decreased over time but remained high at 6 months (40.9%) and at 12 months (19.0%). Conclusion: Anticoagulation use remained high at 6- and 12-months post pLAAO; longer than what’s used in the pivotal trials. Further studies are needed to determine if this is associated with increased bleeding risk. Furthermore, this data should be taken into consideration when assessing stroke risk post pLAAO.