Article ; Online: Left atrial appendage occlusion in atrial fibrillation patients with previous intracranial bleeding: A national multicenter study.
International journal of cardiology
2020 Volume 328, Page(s) 75–80
Abstract: Background: Intracranial hemorrhage (ICH) represents the most serious complication of oral anticoagulant therapy (OAT) in patients with atrial fibrillation (AF), and AF patients with previous ICH are a challenge for clinicians. Left atrial appendage ( ... ...
Abstract | Background: Intracranial hemorrhage (ICH) represents the most serious complication of oral anticoagulant therapy (OAT) in patients with atrial fibrillation (AF), and AF patients with previous ICH are a challenge for clinicians. Left atrial appendage (LAA) occlusion has emerged as an alternative option for AF patients not suitable for OAT. Currently, few data are available on long term outcomes after LAA occlusion in this population. We evaluated the safety and efficacy of LAA occlusion in a cohort of patients with AF and previous ICH. Methods: This is a multicenter, observational, retrospective study involving 5 LAA occlusion centers in Italy. It includes all consecutive patients (n = 120) with previous ICH who underwent LAA occlusion for nonvalvular AF and high thromboembolic risk. Procedural outcomes, post-procedural therapies and 12-months follow-up data were analyzed. Results: The device was successfully implanted in 100% of cases, with a 6% of major peri-procedural complications. 59% had a prior ICH during OAT. The sample had a high risk of stroke (5.18%/year) and bleeding (6.62%/year). 30% were discharged on single and 54.2% on dual antiplatelet therapy. The expected annual risk for thromboembolism was 5.1%. Excluding periprocedural ischemic complications, the stroke annual rate was 1.8%. The expected annual risk of bleeding was 6.7%. The observed annual bleeding rate was 5.45%. Conclusions: Percutaneous LAA occlusion is an effective option for AF patients and previous intracranial hemorrhage. After LAA occlusion, a single antiplatelet therapy strategy could be considered for patients with the highest risk of recurrent bleeding. |
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MeSH term(s) | Anticoagulants/adverse effects ; Atrial Appendage/diagnostic imaging ; Atrial Appendage/surgery ; Atrial Fibrillation/complications ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/drug therapy ; Humans ; Intracranial Hemorrhages/epidemiology ; Italy/epidemiology ; Retrospective Studies ; Stroke/epidemiology ; Stroke/prevention & control ; Treatment Outcome |
Chemical Substances | Anticoagulants |
Language | English |
Publishing date | 2020-11-25 |
Publishing country | Netherlands |
Document type | Journal Article ; Multicenter Study ; Observational Study |
ZDB-ID | 779519-1 |
ISSN | 1874-1754 ; 0167-5273 |
ISSN (online) | 1874-1754 |
ISSN | 0167-5273 |
DOI | 10.1016/j.ijcard.2020.11.045 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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