Ontology type: schema:ScholarlyArticle
2021-11-25
AUTHORSNicolas Dognin, Erwan Salaun, Catherine Champagne, Guillaume Domain, Gilles O’Hara, François Philippon, Jean-Michel Paradis, Laurent Faroux, Jonathan Beaudoin, Kim O’Connor, Mathieu Bernier, Josep Rodés-Cabau, Jean Champagne
ABSTRACTBackground 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 = 5), myelodysplastic syndrome (n = 6), von Willebrand syndrome (n = 4), type A hemophilia (n = 1), and dysfibrinogenemia (n = 1). The HD population’s age ranged from 61 to 87 years, 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 = 9), dual antiplatelet (n = 6), aspirin (n = 1), or no therapy (n = 1) during the first six postoperative weeks, followed with single antiplatelet (n = 16) or no therapy (n = 1) during lifelong. After 20 months, 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 = 212), a baseline history of bleeding was less frequent (53% vs 91%, p < 0.001), and more patients received a perioperative blood transfusion (47% vs 4%, p < 0.001) 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™ 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. Percutaneous 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. More... »
PAGES1-13
http://scigraph.springernature.com/pub.10.1007/s10840-021-01073-0
DOIhttp://dx.doi.org/10.1007/s10840-021-01073-0
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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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9 | ″ | schema: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 = 5), myelodysplastic syndrome (n = 6), von Willebrand syndrome (n = 4), type A hemophilia (n = 1), and dysfibrinogenemia (n = 1). The HD population’s age ranged from 61 to 87 years, 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 = 9), dual antiplatelet (n = 6), aspirin (n = 1), or no therapy (n = 1) during the first six postoperative weeks, followed with single antiplatelet (n = 16) or no therapy (n = 1) during lifelong. After 20 months, 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 = 212), a baseline history of bleeding was less frequent (53% vs 91%, p < 0.001), and more patients received a perioperative blood transfusion (47% vs 4%, p < 0.001) 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™ 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. Percutaneous 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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13 | ″ | schema:isPartOf | sg:journal.1116996 |
14 | ″ | schema:keywords | CHA2DS2VASc |
15 | ″ | ″ | HD carriers |
16 | ″ | ″ | HD group |
17 | ″ | ″ | LAA anatomy |
18 | ″ | ″ | Lifelong |
19 | ″ | ″ | MethodsConsecutive patients |
20 | ″ | ″ | No. 21 |
21 | ″ | ″ | PurposeWe |
22 | ″ | ″ | TEE |
23 | ″ | ″ | Watchman |
24 | ″ | ″ | age |
25 | ″ | ″ | anatomy |
26 | ″ | ″ | anesthesiologists |
27 | ″ | ″ | anticoagulants |
28 | ″ | ″ | antiplatelet |
29 | ″ | ″ | antithrombotic regimes |
30 | ″ | ″ | appendage closure |
31 | ″ | ″ | appendages |
32 | ″ | ″ | approach |
33 | ″ | ″ | aspirin |
34 | ″ | ″ | assessment |
35 | ″ | ″ | atrial appendage |
36 | ″ | ″ | atrial appendage closure |
37 | ″ | ″ | atrial fibrillation |
38 | ″ | ″ | background |
39 | ″ | ″ | baseline characteristics |
40 | ″ | ″ | baseline history |
41 | ″ | ″ | bleeding |
42 | ″ | ″ | blood transfusion |
43 | ″ | ″ | care |
44 | ″ | ″ | carriers |
45 | ″ | ″ | cases |
46 | ″ | ″ | characteristics |
47 | ″ | ″ | clinical outcomes |
48 | ″ | ″ | closure |
49 | ″ | ″ | cohort |
50 | ″ | ″ | complications |
51 | ″ | ″ | contraindications |
52 | ″ | ″ | cornerstone |
53 | ″ | ″ | data |
54 | ″ | ″ | devices |
55 | ″ | ″ | direct oral anticoagulants |
56 | ″ | ″ | discussion |
57 | ″ | ″ | disorders |
58 | ″ | ″ | dual antiplatelet |
59 | ″ | ″ | dysfibrinogenemia |
60 | ″ | ″ | echocardiography |
61 | ″ | ″ | efficacy |
62 | ″ | ″ | experience |
63 | ″ | ″ | factor VIII infusions |
64 | ″ | ″ | feasibility |
65 | ″ | ″ | fibrillation |
66 | ″ | ″ | group |
67 | ″ | ″ | hemarthrosis |
68 | ″ | ″ | hemophilia |
69 | ″ | ″ | hemophilia type A |
70 | ″ | ″ | hemorrhagic complications |
71 | ″ | ″ | hemostasis disorders |
72 | ″ | ″ | history |
73 | ″ | ″ | implantation success rate |
74 | ″ | ″ | indications |
75 | ″ | ″ | infusion |
76 | ″ | ″ | left atrial appendage closure |
77 | ″ | ″ | life-threatening bleeding |
78 | ″ | ″ | males |
79 | ″ | ″ | management |
80 | ″ | ″ | midterm |
81 | ″ | ″ | months |
82 | ″ | ″ | more patients |
83 | ″ | ″ | multidisciplinary approach |
84 | ″ | ″ | multidisciplinary care |
85 | ″ | ″ | myelodysplastic syndrome |
86 | ″ | ″ | non-valvular atrial fibrillation |
87 | ″ | ″ | oral anticoagulants |
88 | ″ | ″ | outcomes |
89 | ″ | ″ | patients |
90 | ″ | ″ | percutaneous left atrial appendage closure |
91 | ″ | ″ | perioperative blood transfusion |
92 | ″ | ″ | periprocedural management |
93 | ″ | ″ | population |
94 | ″ | ″ | population ages |
95 | ″ | ″ | postoperative week |
96 | ″ | ″ | prevention |
97 | ″ | ″ | primary hemostasis disorders |
98 | ″ | ″ | procedural data |
99 | ″ | ″ | procedural indications |
100 | ″ | ″ | procedural success rate |
101 | ″ | ″ | rate |
102 | ″ | ″ | recurrent hemarthrosis |
103 | ″ | ″ | regime |
104 | ″ | ″ | safety outcomes |
105 | ″ | ″ | single antiplatelet |
106 | ″ | ″ | single-center experience |
107 | ″ | ″ | stroke |
108 | ″ | ″ | success rate |
109 | ″ | ″ | syndrome |
110 | ″ | ″ | technical success rate |
111 | ″ | ″ | therapy |
112 | ″ | ″ | thrombocytopenia |
113 | ″ | ″ | transesophageal echocardiography |
114 | ″ | ″ | transfusion |
115 | ″ | ″ | type A |
116 | ″ | ″ | von Willebrand syndrome |
117 | ″ | ″ | weeks |
118 | ″ | ″ | years |
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