Impact of chronic kidney disease on left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation

Kefer, Joëlle; Tzikas, Apostolos; Freixa, Xavier; Shakir, Samera; Gafoor, Sameer; Nielsen‐Kudsk, Jens Erik; Berti, Sérgio; Santoro, Gennaro; Aminian, Adel; Landmesser, Ulf; Nietlispach, Fabiàn; Ibrahim, Réda; Danna, Paolo; Benit, Edouard; Budts, Werner; Stammen, Francis; Potter, Tom De; Tichelbäcker, Tobias; Gloekler, Steffen; Kanagaratnam, Prapa; Costa, Marco A.; Cruz-González, Ignacio; Sievert, Horst; Schillinger, Wolfgang; Park, Jai‐Wun; Meier, Bernhard; Omran, Heyder

doi:10.1016/j.ijcard.2016.01.003

Cited by 96 publications

(77 citation statements)

References 29 publications

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“…During the average follow-up period of 637 days, the CKD group had higher mortality; however, there were no significant differences in major adverse events, including ischemic stroke and major bleeding events, between the groups. Joelle Kefer et al [19] also presented similar conclusions in a similar study using the ACP device; their study demonstrated that the procedural safety and efficacy of LAAC with the ACP device on stroke reduction are similarly high in patients with CKD and patients with normal renal function, with no impact of the CKD stages on the periprocedural MAEs.…”

Section: Discussionmentioning

confidence: 69%

Impact of chronic kidney disease on Watchman implantation: experience with 300 consecutive left atrial appendage closures at a single center

et al. 2018

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The prevalence of chronic kidney disease (CKD) is high in patients with atrial fibrillation (AF). Left atrial appendage closure (LAAC) has been recognized as an efficient alternative to oral anticoagulation for the prevention of thromboembolic events in patients with non-valvular AF (NVAF); however, the long-term safety and efficacy of LAAC in patients with CKD remain unclear. This study was designed to provide data regarding the safety and efficacy of LAAC in NVAF patients with CKD. A real-world analysis of the safety and efficacy of LAAC was performed on a cohort of 300 NVAF patients with or without CKD who underwent LAAC using the Watchman (WM) device at our center. The patients with CKD (n = 151) were significantly older (77.0 ± 7.2 vs. 73.2 ± 7.8 years, respectively, P < 0.0001) and had a higher CHA2DS2-VASc score (4.3 ± 1.5 vs. 3.4 ± 1.4, respectively, P < 0.0001) and HAS-BLED score (4.0 ± 1.0 vs. 3.0 ± 1.0, respectively, P < 0.0001) than the patients without CKD (n = 149). However, there were no differences between groups with respect to the device implant success rate (98.7 vs. 97.3%, respectively, P = 0.446) or severe periprocedural complications within 7 days. The patients were followed up for 637 ± 398 days, and all patients received repeat transesophageal echocardiography (TEE). Thirteen (4.3%) device-related thrombi, 3 (1.0%) ischemic strokes, and 19 (6.3%) non-procedural major bleeding cases were documented, and there were no differences in these complications between groups. The observed rate of all thromboembolic events by Kaplan–Meier analysis decreased by 68.8% (CKD) and 48.6% (non-CKD); moreover, the observed annual rate of bleeding was reduced by 57.5% (CKD) and 11.4% (non-CKD). Our results indicate that LAAC with the WM device is safe and effective in preventing stroke in NVAF patients with and without CKD.

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Section: Discussionmentioning

confidence: 69%

Impact of chronic kidney disease on Watchman implantation: experience with 300 consecutive left atrial appendage closures at a single center

et al. 2018

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“…We feel that, with the considerable uncertainties and risk for harm, a trial of warfarin (or NOACs after an improved understanding of their actions with an eGFR,30 ml/min per 1.73 m 2 ) versus placebo is warranted. Another promising therapy is left atrial appendage closure, which in early observational studies demonstrates a significant reduction in stroke and/or hemorrhage in CKD patients (46).…”

Section: Discussionmentioning

confidence: 99%

Use of Oral Anticoagulation in the Management of Atrial Fibrillation in Patients with ESRD: Con

Keskar

Sood

2016

CJASN

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Among patients with atrial fibrillation, prophylaxis for stroke prevention with the use of anticoagulation is well established in the general population. A number of randomized controlled trials and evidence-based risk prediction tools clearly delineate the benefit and risks of therapy. Despite the high incidence of atrial fibrillation in the late stage CKD and ESRD populations, little high quality evidence exists in these populations. Is it appropriate then to extrapolate findings from the general population to those with CKD/ESRD? In our view, too much uncertainty exists regarding proof of efficacy with clear signals of harm. Routine anticoagulation for stroke prevention in atrial fibrillation is not recommended for the majority of CKD and ESRD patients.

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“…Existing randomized clinical trials of LAAC therapy uniformly excluded patients with advanced chronic kidney disease (CKD) and ESRD. In a large observational registry of LAAC with WATCHMAN, advanced CKD and ESRD (eGRR < 30 mL/min/1.73 m 2 ) were not predictive of adjusted risk for stroke (HR, 2.24; 95% CI, 0.27‐17.9; P = .44) or periprocedural adverse events . A smaller study of 189 patients undergoing LAAC found low complication rates in patients with CKD undergoing LAAC, albeit with a trend toward more DRT in patients with eGFR < 30 mL/min/1.73 m 2 (13.3% vs 5.1%; P = .1) .…”

Section: Laac and Doac In Unique Subgroupsmentioning

confidence: 97%

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

Black‐Maier

Piccini

Granger

2019

Cardiovasc electrophysiol

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Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and confers a fivefold increased risk for stroke. Cardioembolic stroke secondary to AF is a devastating event, but is largely preventable with appropriate oral anticoagulation (OAC). The PROTECT and PREVAIL trials demonstrated that the WATCHMAN left atrial appendage closure (LAAC) device in combination with short‐term warfarin therapy is noninferior to long‐term warfarin with respect to a composite endpoint of stroke, cardiovascular death, and systemic embolism. Importantly, the WATCHMAN confers a significant reduction in life‐threatening bleeding compared to OAC. Although direct‐acting oral anticoagulant (DOAC) are superior to warfarin in eligible patients, several important AF populations exist in whom left atrial appendage (LAA) closure may be preferable to DOAC. Populations warranting strong consideration of LAAC include patients with contraindications to DOAC, end‐stage renal disease, prior intracranial hemorrhage, recurrent gastrointestinal bleeding, and patients undergoing transcatheter aortic valve replacement or left atrial electrical isolation. Device‐related thrombosis is an important complication of LAAC, and DOAC may be preferential to warfarin for prevention and treatment of this complication remains unexplored. Prospective clinical trials comparing DOAC to LAAC in these unique populations are either ongoing or needed.

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Impact of chronic kidney disease on left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation

Cited by 96 publications

References 29 publications

Impact of chronic kidney disease on Watchman implantation: experience with 300 consecutive left atrial appendage closures at a single center

Impact of chronic kidney disease on Watchman implantation: experience with 300 consecutive left atrial appendage closures at a single center

Use of Oral Anticoagulation in the Management of Atrial Fibrillation in Patients with ESRD: Con

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

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