Percutaneous left atrial appendage closure in patients with primary hemostasis disorders and atrial fibrillation View Full Text


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Article Info

DATE

2021-11-25

AUTHORS

Nicolas 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

ABSTRACT

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. More... »

PAGES

1-13

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10840-021-01073-0

DOI

http://dx.doi.org/10.1007/s10840-021-01073-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1143056625

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/34822043


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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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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
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91 perioperative blood transfusion
92 periprocedural management
93 population
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95 postoperative week
96 prevention
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98 procedural data
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100 procedural success rate
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105 single antiplatelet
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107 stroke
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109 syndrome
110 technical success rate
111 therapy
112 thrombocytopenia
113 transesophageal echocardiography
114 transfusion
115 type A
116 von Willebrand syndrome
117 weeks
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