Safety and Efficacy of Left Atrial Appendage Closure Versus Antithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Drug-Eluting Stent Implantation Due to Complex Coronary Artery Disease

Yonsei University

Status and phase: Terminated; Phase 4

Conditions: Coronary Artery Disease; Atrial Fibrillation

Treatments: Device: Amplazter Cardiac Plug (ACP); Drug: Dabigatrain plus clopidogrel; Drug: Dabigatrain plus aspirin

Study type: Interventional

Funder types: Other

Identifiers

NCT02606552

1-2014-0074

Details and patient eligibility

About

Comparatively analyze the safety and validity of Amplazter Cardiac Plug (ACP) device-using percutaneous left atrial appendage closure, and the medical treatment with dabigatran plus aspirin or dabigatran plus clopidogrel after 3months triple therapy (Dabigatran plus DAPT (dual-antiplatelet therapy)) in patient with coronary artery disease treated with drug-eluting stent, accompanying atrial fibrillation.

Total of 670 patients [left atrial appendage occlusion registry with 100 ACP/ 570 anti-coagulation registry: (285 Dabigatran plus aspirin) and (285 Dabigatran plus clopidogrel) therapy)] will be comparatively analyzed the safety and efficacy. Primary endpoints were a composite of death, non-fatal myocardial infarction, stroke, systemic embolism, and GUSTO bleeding (moderate to severe).

Enrollment: 9 patients

Sex: All

Ages: 20+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Patients older than 20 years accompanying chronic atrial fibrillation with CHADS2 score ≥2
2. Patients with coronary artery disease (which requires DES) should receive the 2nd generation drug-eluting stent insertion treatment
3. Subjects and their legal representatives must understand the main purpose of this study, agree with relevant provisions, and sign to consent forms approved by IRBs of each institution.
4. Subjects should agree with the follow-up studies as (coronary angiography) and transesophageal echocardiography, etc.
5. Subjects should agree to follow our requests for post-operative follow-up visits.

Exclusion criteria

1. Patients showing any hypersensitive reaction or reason for restriction to aspirin, heparin, clopidogrel, or warfarin, or otherwise, susceptible to contrast media, and therefore, who could not use those drugs and who were pregnant or breast feeding.
2. Comorbidities other than atrial fibrillation that required chronic warfarin use.
3. Patients diagnosed with progressive infection condition or endocarditis.
4. Patients who have been diagnosed with progressive gastric ulcer or upper gastrointestinal bleeding for last 3 months.
5. Hemodynamically unstable patients who needs inotropic supports.
6. Senile dementia patients who have experienced any cerebrovascular accident (CVA) for last 6 weeks.
7. Patients who have been diagnosed with intracardiac mass, thrombus, or vegetation as echocardiographic findings.
8. Patients diagnosed with severe left ventricular dysfunction (<LVEF 30%).
9. Patients with blood disorder as followings: leucopenia (<WBC 3,000mm3), acute anemia (<Hg 9mg %), Thrombocytopenia (<100,000 platelets/mm3), or any evidence of bleeding or clotting disorders.
10. Patients showing life expectancy less than 12 months because of noncardiac comorbidities.
11. Patients having severe vein occlusion at femoral vein, ceiling vein, or inferior vena cava.
12. A patent foramen ovale with atrial septal aneurysm and right-to-left shunt
13. Symptomatic carotid artery disease
14. Patients with severe valvular heart disease
15. Patients who are currently participating in other clinical trials for any drug or medical device.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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9 participants in 3 patient groups

Dabigatran plus aspirin

Active Comparator group

Description:

Medical treatment with dabigatran plus aspirin after 3months triple therapy (Dabigatran plus DAPT (dual-antiplatelet therapy))

Treatment:

Drug: Dabigatrain plus aspirin

Dabigatran plus clopidogrel

Experimental group

Description:

medical treatment with dabigatran plus clopidogrel after 3months triple therapy (Dabigatran plus DAPT)

Treatment:

Drug: Dabigatrain plus clopidogrel

Amplazter Cardiac Plug (ACP)

Other group

Description:

Amplazter Cardiac Plug (ACP) device-using percutaneous left atrial appendage closure

Treatment:

Device: Amplazter Cardiac Plug (ACP)