Left atrial appendage occlusion in atrial fibrillation patients with previous intracranial bleeding: A national multicenter study.
Int J Cardiol
; 328: 75-80, 2021 04 01.
Article
en En
| MEDLINE
| ID: mdl-33245957
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.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Fibrilación Atrial
/
Apéndice Atrial
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Accidente Cerebrovascular
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
/
Risk_factors_studies
País/Región como asunto:
Europa
Idioma:
En
Revista:
Int J Cardiol
Año:
2021
Tipo del documento:
Article