Observed versus Expected Ischemic and Bleeding Events Following Left Atrial Appendage Occlusion

Busu, Tatiana; Khan, Safi U.; Al-Hajji, Muhammad; Alqahtani, Fahad; Holmes, David R.; Alkhouli, Mohamad

doi:10.1016/j.amjcard.2020.02.041

Cited by 27 publications

(18 citation statements)

References 28 publications

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“…On the other hand, major bleeding event was merely documented in one case on NOAC in our study. A remarkable reduction compared to the predicted rates based on baseline HAS-BLED score was calculated as 56.18%, comparable to what was reported in registries concerning LAAO in the general AF population 29 . Since HCM patients with AF were formally excluded from LAAO trials and the related post-implant antithrombotic researches, there is few data supporting any types and dosage of reliable post-LAAO pharmacology for them.…”

Section: Discussionsupporting

confidence: 83%

Feasibility and efficacy of percutaneous left atrial appendage occlusion in hypertrophic cardiomyopathy patients with atrial fibrillation

Zhang

Jin

Chen

et al. 2020

Preprint

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Background: Prophylactic anticoagulation was recommended for stroke prevention in patients with hypertrophic cardiomyopathy(HCM) and atrial fibrillation(AF) regardless of CHA2DS2-VASC score but the strategy was in a dilemma for patients with contraindication to antigulants. Aims: To estimate the safety and efficacy of left atrial appendage occlusion(LAAO) in HCM patients with atrial fibrillation(AF). Methods and results: This prospective study included 25 HCM patients(age 70.04±11.62years, 72% male, 16/25(64.00%) had prior stroke) with AF eligible for LAAO. Clinical outcomes and echocardiographic parameters were collected and assessed during procedure and follow-up(3, 6, and 12months post-procedure). The composite safety outcomes included all-cause death, major bleeding and procedure-related complications. The primary efficacy outcome was defined as ischemic stroke and systemic embolization. Successful implantation was achieved in 24 patients(96%) using Watchman device without severe peri-device leaks (PDL), while one patient developed new-onset thrombus before access puncture on the operative day. Median follow-up was 1.5 years with a total of 38.1 patient-years. Only one patient experienced non-disabling ischemic stroke. The occurrence of major bleeding was 1/24(4.17%), with a remarkable reduction in annual 3 bleeding risk by 56.18% compared to the predicted rate. Device-related thrombus(DRT) was detected in 3/24(12.50%) patients. Neither serious procedure-related complications nor death events were reported in our study. Conclusion: Our study suggested the feasibility and safety of LAAO in HCM patients for stroke prevention. Whereas, thrombus formation remains a concern depending on hemodynamic abnormality associated with HCM. Further follow-up visits on larger sample size would facilitate the evaluation of LAAO in this high-risk cohort.

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Section: Discussionsupporting

confidence: 83%

Feasibility and efficacy of percutaneous left atrial appendage occlusion in hypertrophic cardiomyopathy patients with atrial fibrillation

Zhang

Jin

Chen

et al. 2020

Preprint

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“…Numerous observational studies performed with the Watchman, Amulet and newer LAAO dedicated-devices support the use of an initial DAPT transition for 1 to 6 months following LAAO, Figure 4B-4C. Regarding bleeding events, several single-arm studies as well as a recent meta-analysis including 11.071 patients [23], have reported substantial reductions in the observed versus predicted bleeding rates, according to HAS-BLED Score employing a short-term DAPT scheme.…”

Section: Patients Ineligible For Transient Oacmentioning

confidence: 97%

“…DRT is independently associated with a 4-to 5-fold increase in the risk of ischemic events [31][32] and warrants intensification of antithrombotic therapy with vitamin K antagonists, DOACs or low-weight molecular heparin for 4-12 weeks [3]. Notwithstanding, the majority of patients presenting DRT do not develop any thromboembolic complications [23,32].…”

Section: Device-related Thrombusmentioning

confidence: 99%

Percutaneous left atrial appendage occlusion in the current practice

Cruz-González

Trejo-Velasco

2021

Kardiol Pol

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“…Although a large number of studies was recently published suggesting efficacy of LAAC in real-world, those observational studies compared the efficacy of LAAC to a theoretical risk predicted by the CHA 2 DS 2 -VASc score. 8 Albeit commonly used, the CHA 2 DS 2 -VASc score does not account for key risk factors for stroke in NVAF (duration of atrial fibrillation, left atrial size, left atrial appendage [LAA] shape and function, etc), and has been found to have a modest predictive value overall. 9 In addition, there are, to date, no comparative data between LAAC and direct oral anticoagulants which are known to be associated with lower odds of hemorrhagic strokes than Warfarin.…”

Section: Efficacy Datamentioning

confidence: 99%