Left Atrial Appendage Occlusion in High Bleeding Risk Patients

• Published in: Journal of interventional cardiology 2019, Vol.2019 (2019), p.1-7
• Main Authors: Casu, Gavino, Mazzone, Patrizio, Berne, Paola, Viola, Graziana, Decandia, Federica, Sechi, Filomena, Delitala, Alessandro P., Lorenzoni, Giovanni, Merella, Pierluigi, Deiana, Gianluca
• Format: Article
• Language: English
• Subjects: Aged; Anticoagulants; Anticoagulants (Medicine); Antiplatelet therapy; Atrial Appendage - surgery; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - epidemiology; Atrial Fibrillation - surgery; Bleeding; Blood clot; Blood clots; Cardiac arrhythmia; Cardiology; Care and treatment; Collaboration; Contraindications, Drug; Female; Fibrillation; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Heart; Hemorrhage - chemically induced; Hemorrhage - prevention & control; Humans; Italy - epidemiology; Male; Medical research; Medicine, Experimental; Occlusion; Patients; Prevention; Prosthesis Implantation - adverse effects; Prosthesis Implantation - instrumentation; Prosthesis Implantation - methods; Risk Adjustment - methods; Risk factors; Septal Occluder Device; Stroke; Stroke - etiology; Stroke - prevention & control; Stroke patients; Success; Systematic review; Thromboembolism; Thrombosis; Ticagrelor; Treatment Outcome; Working groups
• ISSN: 0896-4327; 1540-8183
• DOI: 10.1155/2019/6704031

Objectives. The aim of this study was to investigate the outcomes of left atrial appendage occlusion (LAAO) in high bleeding risk patients suffering atrial fibrillation (AF) and to analyze the different antithrombotic therapies following the intervention. Background. Methods. This monocentric study included 68 patients with nonvalvular AF with an absolute contraindication to OAT or at high bleeding risk. Follow-up was done with a clinical visit at 3-6-12 months. Results. Successful LAAO was achieved in 67/68 patients. At discharge, 32/68 patients were on dual antiplatelet therapy (APT), 34/68 were without any antithrombotic therapy or with a single antiplatelet drug, and 2/68 were on anticoagulant therapy. At three-month follow-up visit, 73.6% of the patients did not receive dual APT, of whom 14.7% had no thrombotic therapy and 58.9% were on single antiplatelet therapy. During a follow-up of 1.4 ± 0.9 years, 3/62 patients had late adverse effects (2 device-related thrombus without clinical consequences and 1 extracranial bleeding). The device-related thrombosis was not related to the antithrombotic therapy. Conclusions. LAAO is feasible and safe and prevents stroke in patients with AF with contraindication to oral anticoagulant therapy. After LAAO, single antiplatelet therapy seems to be a safe alternative to dual antiplatelet therapy, especially in patients at high bleeding risk. No benefit has been observed with dual APT.