Percutaneous left atrial appendage closure in patients with prior intracranial bleeding and thromboembolism.
Aged
Atrial Appendage
/ diagnostic imaging
Atrial Fibrillation
/ complications
Cardiac Catheterization
/ methods
Cardiac Surgical Procedures
/ methods
Female
Follow-Up Studies
Humans
Intracranial Hemorrhages
/ etiology
Male
Registries
Retrospective Studies
Thromboembolism
/ etiology
Treatment Outcome
Atrial fibrillation
Intracranial bleeding
Left atrial appendage closure
Stroke
Thromboembolism
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
01
12
2019
accepted:
28
01
2020
pubmed:
10
2
2020
medline:
17
6
2021
entrez:
10
2
2020
Statut:
ppublish
Résumé
Percutaneous left atrial appendage closure (LAAC) is an alternative treatment in atrial fibrillation patients with contraindication to oral anticoagulation. However, patient selection criteria for LAAC are debated. The purpose of this study was to evaluate the outcome after LAAC in patients with prior intracranial bleeding and thromboembolism. Consecutive patients with atrial fibrillation and prior intracranial bleeding who underwent LAAC from February 2009 to August 2018 at the Turku University Hospital, Finland, were included in a prospective registry. Patients were followed through clinical visits and annual phone calls up to 5 years. Overall 104 patients (mean age 73 ± 7 years; 30% women; CHA₂DS₂-VASc score 4.7 ± 1.4; HAS-BLED score 3.3 ± 0.9) with atrial fibrillation and prior intracranial bleeding underwent successful LAAC using mainly (n = 102) Amplatzer devices. Median time from intracranial bleeding to LAAC was 7 months, and median follow-up 3.6 years. Antithrombotic treatment was ≤6 months in 71 patients (68%), and 48 patients (46%) received aspirin or clopidogrel alone. The rates of thromboembolism and intracranial bleeding (per 100 patient-years) were 3.4 and 1.9, respectively. In 39 patients with previous thromboembolism, the rate of thromboembolism was 3.6 per 100 patient-years (95% confidence interval 1.5-7.0), yielding a 69% relative risk reduction with respect to predicted risk based on median CHA Percutaneous LAAC with minimized antithrombotic treatment was demonstrated to be a valid treatment option in high-risk patients with prior intracranial bleeding and thromboembolism.
Sections du résumé
BACKGROUND
Percutaneous left atrial appendage closure (LAAC) is an alternative treatment in atrial fibrillation patients with contraindication to oral anticoagulation. However, patient selection criteria for LAAC are debated.
OBJECTIVE
The purpose of this study was to evaluate the outcome after LAAC in patients with prior intracranial bleeding and thromboembolism.
METHODS
Consecutive patients with atrial fibrillation and prior intracranial bleeding who underwent LAAC from February 2009 to August 2018 at the Turku University Hospital, Finland, were included in a prospective registry. Patients were followed through clinical visits and annual phone calls up to 5 years.
RESULTS
Overall 104 patients (mean age 73 ± 7 years; 30% women; CHA₂DS₂-VASc score 4.7 ± 1.4; HAS-BLED score 3.3 ± 0.9) with atrial fibrillation and prior intracranial bleeding underwent successful LAAC using mainly (n = 102) Amplatzer devices. Median time from intracranial bleeding to LAAC was 7 months, and median follow-up 3.6 years. Antithrombotic treatment was ≤6 months in 71 patients (68%), and 48 patients (46%) received aspirin or clopidogrel alone. The rates of thromboembolism and intracranial bleeding (per 100 patient-years) were 3.4 and 1.9, respectively. In 39 patients with previous thromboembolism, the rate of thromboembolism was 3.6 per 100 patient-years (95% confidence interval 1.5-7.0), yielding a 69% relative risk reduction with respect to predicted risk based on median CHA
CONCLUSION
Percutaneous LAAC with minimized antithrombotic treatment was demonstrated to be a valid treatment option in high-risk patients with prior intracranial bleeding and thromboembolism.
Identifiants
pubmed: 32036026
pii: S1547-5271(20)30083-7
doi: 10.1016/j.hrthm.2020.01.028
pii:
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
915-921Informations de copyright
Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.