Impact of gender in patients with device-related thrombosis after left atrial appendage closure -- a sub-analysis from the multicenter EUROC-DRT-registry

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.