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    "description": "Background or purposeWe report our single-center experience with percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) and primary hemostasis disorders (HD).MethodsConsecutive patients with primary HD who underwent a percutaneous LAAC were included. Baseline characteristics, procedural data, and clinical outcomes were prospectively collected and compared with the overall LAAC cohort without HD.ResultsSince 2013, among 229 LAAC, 17 patients (7%) had a primary HD: thrombocytopenia (n\u2009=\u20095), myelodysplastic syndrome (n\u2009=\u20096), von Willebrand syndrome (n\u2009=\u20094), type A hemophilia (n\u2009=\u20091), and dysfibrinogenemia (n\u2009=\u20091). The HD population\u2019s age ranged from 61 to 87\u00a0years, and the median CHA2DS2VASc was 5. Periprocedural plasmatic management was required in 47% of patients. The immediate LAAC implantation success rate was 100%. Patients received a direct oral anticoagulant (DOA) (n\u2009=\u20099), dual antiplatelet (n\u2009=\u20096), aspirin (n\u2009=\u20091), or no therapy (n\u2009=\u20091) during the first six postoperative weeks, followed with single antiplatelet (n\u2009=\u200916) or no therapy (n\u2009=\u20091) during lifelong. After 20\u00a0months, the technical success rate and procedural success rate were 100% and 94%. Zero device-/procedure-related complication and only one life-threatening bleeding occurred. Compared to patients without HD (n\u2009=\u2009212), a baseline history of bleeding was less frequent (53% vs 91%, p\u2009<\u20090.001), and more patients received a perioperative blood transfusion (47% vs 4%, p\u2009<\u20090.001) in the HD group. The efficacy and safety outcomes did not differ between HD and non-HD cohorts.ConclusionsPercutaneous LAAC in primary HD carriers appeared as safe and as effective as in overall LAAC population for stroke and bleeding prevention at midterm follow-up.Graphical abstractPercutaneous left atrial appendage closure in patients with atrial fibrillation and primary hemostasis disorders. The percutaneous LAAC in primary hemostasis disorders and AF carriers requires a multidisciplinary approach. Cardiologist, anesthesiologist, and hematologist discussion is a cornerstone to assess anticoagulant contraindication, LAAC feasibility, periprocedural management, and follow-up (high). This multidisciplinary care is illustrated by the case of a 61-year-old male with hemophilia type A and recurrent hemarthrosis. Pre-LAAC assessment confirmed procedural indication and cactus LAA anatomy (left). After plasmatic management with factor VIII infusion, a WATCHMAN\u2122 no. 21 was successfully implanted (middle). During follow-up, without antithrombotic regime, no ischemic or hemorrhagic complication occurred (right). LAA, left atrial appendage; LAAC, left atrial appendage closure; TEE, transesophageal echocardiography.\u00a0Percutaneous LAAC in primary HD carriers appeared as safe and as effective as in overall LAAC population for stroke and bleeding prevention at midterm follow-up.", 
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