{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:43:58Z","timestamp":1792683838196,"version":"4.5.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2020,7]]},"abstract":"\n Background:<\/jats:title>\n Percutaneous left atrial appendage closure (LAAC) exposes to the risk of device thrombosis in patients with atrial fibrillation who frequently have a contraindication to full anticoagulation. Thereby, dual antiplatelet therapy (DAPT) is usually preferred. No randomized study has evaluated nonvitamin K antagonist oral anticoagulant after LAAC, and we decided to evaluate the efficacy and safety of reduced doses of rivaroxaban after LAAC.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n ADRIFT (Assessment of Dual Antiplatelet Therapy Versus Rivaroxaban in Atrial Fibrillation Patients Treated With Left Atrial Appendage Closure) is a multicenter, phase IIb study, which randomized 105 patients after successful LAAC to either rivaroxaban 10 mg (R\n 10<\/jats:sup>\n , n=37), rivaroxaban 15 mg (R\n 15<\/jats:sup>\n , n=35), or DAPT with aspirin 75 mg and clopidogrel 75 mg (n=33). The primary end point was thrombin generation (prothrombin fragments 1+2) measured 2 to 4 hours after drug intake, 10 days after treatment initiation. Thrombin-antithrombin complex, D-dimers, rivaroxaban concentrations were also measured at 10 days and 3 months. Clinical end points were evaluated at 3-month follow-up.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The primary end point was reduced with R\n 10<\/jats:sup>\n (179 pmol\/L [interquartile range (IQR), 129\u2013273],\n P<\/jats:italic>\n <0.0001) and R\n 15<\/jats:sup>\n (163 pmol\/L [IQR, 112\u2013231],\n P<\/jats:italic>\n <0.0001) as compared with DAPT (322 pmol\/L [IQR, 218\u2013528]). We observed no significant reduction of the primary end point between R\n 10<\/jats:sup>\n and R\n 15<\/jats:sup>\n while rivaroxaban concentrations increased significantly from 184 ng\/mL (IQR, 127\u2013290) with R\n 10<\/jats:sup>\n to 274 ng\/mL (IQR, 192\u2013377) with R\n 15<\/jats:sup>\n ,\n P<\/jats:italic>\n <0.0001. Thrombin-antithrombin complex and D-dimers were numerically lower with both rivaroxaban doses than with DAPT. These findings were all confirmed at 3 months. The clinical end points were not different between groups. A device thrombosis was noted in 2 patients assigned to DAPT.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Thrombin generation measured after LAAC was lower in patients treated by reduced rivaroxaban doses than DAPT, supporting an alternative to the antithrombotic regimens currently used after LAAC and deserves further evaluation in larger studies.<\/jats:p>\n <\/jats:sec>\n \n Registration:<\/jats:title>\n \n URL:\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier: NCT03273322.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/circinterventions.119.008481","type":"journal-article","created":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T05:00:30Z","timestamp":1594962030000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":81,"title":["Reduced Rivaroxaban Dose Versus Dual Antiplatelet Therapy After Left Atrial Appendage Closure"],"prefix":"10.1161","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct03273322","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Guillaume","family":"Duthoit","sequence":"first","affiliation":[{"name":"Sorbonne Universit\u00e9, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanne","family":"Silvain","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eloi","family":"Marijon","sequence":"additional","affiliation":[{"name":"European Georges Pompidou Hospital, APHP; Paris Descartes University, INSERM U 970, France (E.M., C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gr\u00e9gory","family":"Ducrocq","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, H\u00f4pital Bichat, AP-HP, Universit\u00e9 Paris-Diderot, Inserm U1148, France (G.D., E.B., J.-M.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Lepillier","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France (A.L., D.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"Frere","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, Department of Haematology Biologic, APHP Piti\u00e9-Salp\u00eatri\u00e8re Hospital; INSERM UMRS 1166, Institute of Cardiometabolism And Nutrition, Paris, France (C.F., I.M.-T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solohaja-Faniaha","family":"Dimby","sequence":"additional","affiliation":[{"name":"Unit\u00e9 de Recherche Clinique, ACTION Study Group, H\u00f4pital Fernand Widal (AP-HP), SAMM - Statistique, Analyse et Mod\u00e9lisation Multidisciplinaire EA 4543, Universit\u00e9 Paris 1 Panth\u00e9on Sorbonne, France (S.-F.D., E.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Batric","family":"Popovic","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, D\u00e9partement de Cardiologie, Centre Hospitalier Universitaire Brabois, Nancy, France (B.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Lellouche","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHU Henri Mondor, Cr\u00e9teil, France (N.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Martin-Toutain","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, Department of Haematology Biologic, APHP Piti\u00e9-Salp\u00eatri\u00e8re Hospital; INSERM UMRS 1166, Institute of Cardiometabolism And Nutrition, Paris, France (C.F., I.M.-T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Spaulding","sequence":"additional","affiliation":[{"name":"European Georges Pompidou Hospital, APHP; Paris Descartes University, INSERM U 970, France (E.M., C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Brochet","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, H\u00f4pital Bichat, AP-HP, Universit\u00e9 Paris-Diderot, Inserm U1148, France (G.D., E.B., J.-M.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Attias","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France (A.L., D.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Mansourati","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHRU Brest, Universit\u00e9 de Bretagne Occidentale, EA 4324 (J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Lorgis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Laboratory of Cerebro-Vascular Pathophysiology and epidemiology (PEC2) EA 7460, University of Burgundy, Dijon, France (L.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Klug","sequence":"additional","affiliation":[{"name":"Univ. Lille CHU Lille, F-59000 Lille, France (D.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noura","family":"Zannad","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, CHR Metz-Thionville, France (N.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Hauguel-Moreau","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Versailles-Saint Quentin, Department of Cardiology, Ambroise Par\u00e9 Hospital (AP-HP), INSERM U-1018, Boulogne, France (M.H.-M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nassim","family":"Braik","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandrine","family":"Deltour","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, Urgences Cerebro-Vasculaires Piti\u00e9-Salp\u00eatri\u00e8re Hospital (AP-HP), INSERM UMR U-942, Paris, France (S.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Ceccaldi","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China (H.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadjib","family":"Hammoudi","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delphine","family":"Brugier","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9, ACTION Study Group (Allies in Cardiovascular Trials, Initiatives and Organized Networks), INSERM UMRS1166, ICAN, H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re (AP-HP), Paris, France (G.D., J.S., N.B., A.C., N.H., D.B., G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Vicaut","sequence":"additional","affiliation":[{"name":"Unit\u00e9 de Recherche Clinique, ACTION Study Group, H\u00f4pital Fernand Widal (AP-HP), SAMM - 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