EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update

Glikson, Michael; Wolff, Rafael; Hindricks, Gerhard; Mandrola, John; Camm, A. John; Lip, Gregory Y.H.; Fauchier, Laurent; Betts, Timothy R.; Lewalter, Thorsten; Saw, Jacqueline; Tzikas, Apostolos; Sternik, Leonid; Nietlispach, Fabiàn; Berti, Sérgio; Sievert, Horst; Bertog, Stefan; Meier, Bernhard

doi:10.4244/eijy19m08_01

Cited by 212 publications

(202 citation statements)

References 196 publications

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“…Few data are available about LAA occlusion outcomes in CKD patients. Case reports in ESRD dialysis patients, retrospectively collected, have been described (10)(11)(12). A retrospective analysis of patients undergoing the procedure showed that CKD patients, when compared to non-CKD patients, had a greater number of events at follow-up and a higher risk of acute renal failure associated with the procedure [20].…”

Section: Discussionmentioning

confidence: 99%

“…In the last years, Left Atrial Appendage (LAA) occlusion has emerged as an alternative option to OAT for AF patients who are at high thromboembolic risk [9] and not suitable for OAT and recent cardiology guidelines state that LAA occlusion should be considered in this subset of patients [10]. Retrospective studies suggest the efficacy of LAA occlusion in reducing thromboembolic risk in patients with chronic kidney disease (CKD), but very few data are available on outcomes in ESRD patients [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis

et al. 2020

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Background In patients with end stage renal disease and atrial fibrillation (AF), undergoing chronic dialysis, direct oral agents are contraindicated and warfarin does not fully prevent embolic events while increasing the bleeding risk. The high hemorrhagic risk represents the main problem in this population. Aim of the study was to estimate the safety and efficacy for thromboembolic prevention of left atrial appendage (LAA) occlusion in a cohort of dialysis patients with AF and high hemorrhagic risk. Methods Ninety-two dialysis patients with AF who underwent LAA occlusion were recruited. For comparative purposes, two cohorts of dialysis patients with AF, one taking warfarin (oral anticoagulant therapy, OAT cohort, n = 114) and the other not taking any OAT (no-therapy cohort, n = 148) were included in the study. Primary endpoints were (1) incidence of peri-procedural complications, (2) incidence of 2-year thromboembolic and hemorrhagic events, (3) mortality at 2 years. In order to evaluate the effect of the LAA occlusion on the endpoints with respect to the OAT and No-therapy cohorts, a multivariable Cox regression model was applied adjusted for possible confounding factors. Results The device was successfully implanted in 100% of cases. Two major peri-procedural complications were reported. No thromboembolic events occurred at 2-year follow-up. The adjusted multivariable Cox regression model showed no difference in bleeding risk in the OAT compared to the LAA occlusion cohort in the first 3 months of follow-up [HR 1.65 (95% CI 0.43-6.33)], when most of patients were taking two antiplatelet drugs. In the following 21 months the bleeding incidence became higher in OAT patients [HR 6.48 (95% CI 1.32-31.72)]. Overall mortality was greater in both the OAT [HR 2.76 (95% CI 1.31-5.86)] and No-Therapy [HR 3.09 (95% CI 1.59-5.98)] cohorts compared to LAA occlusion patients. Conclusions The study could open the way to a non-pharmacological option for thromboembolic protection in dialysis patients with AF and high bleeding risk.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis

et al. 2020

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“…With the development of NOACs, like dabigatran, rivaroxaban, apixaban, and edoxaban, direct thrombin, or factor X inhibitors, the use of vitamin K antagonists is in decline 11,12 . However, over the last decade, percutaneous closure of left atrial appendage closure (LAAC) proved effective in reducing thromboembolic complications in patients with oral treatment contraindications 13,14 . The 5‐year outcome of both the PREVAIL and PROTECT prospective randomized trials demonstrated that LAAC provided comparable stroke reduction compared to warfarin, with an additional reduction in major bleeding, in particularly hemorrhagic stroke 15 .…”

Section: Discussionmentioning

confidence: 99%

A rare case of acquired factor V inhibitor, during treatment with dabigatran for chronic atrial fibrillation, successfully treated with bypassing agents

Giuffrida

Markovic

Nicolosi

et al. 2020

Clinical Case Reports

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“…Bleeding rates are substantially reduced using the concept of dual therapy, but recurrent bleeding events may still occur in patients with very high bleeding risk. In these patients occlusion of the left atrial appendage is recommended [30].…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Necessity of Antiaggregation and Anticoagulation and Its Prognostic Impact: A Cardiologist’s View

Hink

Voigtländer

2020

Visc Med

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Background: In modern cardiology, anticoagulation and antiaggregation are key components of current treatment strategies. However, in patients treated with anticoagulation and antiplatelet substances, bleeding is a major risk. Findings: In all major cardiovascular diseases, a multitude of studies have shown a positive impact of antithrombotic treatment on cardiovascular death. In patients with higher bleeding risks, recent studies showed the safety of reducing the period of dual antiplatelet therapy (DAPT), i.e., after percutaneous coronary intervention. In patients with coronary artery disease and atrial fibrillation (AF), triple therapy including DAPT and anticoagulation is associated with very high bleeding risks. However, recently published data showed the safety of direct oral anticoagulants (DOACs) and P2Y12 inhibitors only compared to vitamin K antagonist (VKA) and DAPT. Anticoagulation in nonvalvular AF reduces major cerebrovascular ischemic events. However, the inherent cerebrovascular bleeding risk is an important concern of this treatment. With the advent of DOACs, this risk could be reduced compared to VKA. Furthermore, anticoagulation and antiaggregation are crucial after treatment of valve disease, both after surgical and interventional procedures. Even in heart failure, new data show benefits using antithrombot-ic substances. Conclusions: Anticoagulation and antiaggregation are of major prognostic relevance in cardiovascular diseases. However, the inherent bleeding risk has to be considered.

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EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion – an update

Abstract: Chapter 1. Background and pathophysiology of thrombus formation in the left atrium

Cited by 212 publications

References 196 publications

Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis

Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis

A rare case of acquired factor V inhibitor, during treatment with dabigatran for chronic atrial fibrillation, successfully treated with bypassing agents

Necessity of Antiaggregation and Anticoagulation and Its Prognostic Impact: A Cardiologist’s View

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