1. Early Nonprocedural Bleeding After Left Atrial Appendage Occlusion.
- Author
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Mesnier J, Cruz-González I, Guedeney P, Arzamendi D, Freixa X, Nombela-Franco L, Peral V, Caneiro-Queija B, Mangieri A, Trejo-Velasco B, Asmarats L, Cepas-Guillén P, Salinas P, Siquier-Padilla J, Estevez-Loureiro R, Laricchia A, O'Hara G, Montalescot G, and Rodés-Cabau J
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Anticoagulants adverse effects, Anticoagulants therapeutic use, Anticoagulants administration & dosage, Dual Anti-Platelet Therapy adverse effects, Europe, Fibrinolytic Agents adverse effects, Fibrinolytic Agents administration & dosage, Incidence, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States epidemiology, Atrial Appendage physiopathology, Atrial Appendage diagnostic imaging, Atrial Fibrillation mortality, Atrial Fibrillation diagnosis, Atrial Fibrillation complications, Cardiac Catheterization adverse effects, Cardiac Catheterization instrumentation, Cardiac Catheterization mortality, Hemorrhage etiology, Platelet Aggregation Inhibitors adverse effects, Platelet Aggregation Inhibitors therapeutic use
- Abstract
Background: Patients treated with left atrial appendage occlusion (LAAO) are at high bleeding risk. Intensive antithrombotic treatment is recommended after the procedure to prevent device-related thrombosis., Objectives: This study sought to evaluate the incidence, consequences, and predictors of early nonprocedural bleeding after LAAO., Methods: This was a multicenter study including 1,649 patients undergoing LAAO in 9 centers. Early nonprocedural bleeding was defined as bleeding unrelated to the procedure occurring within 3 months after device implantation. The severity of bleeding was defined by the Valve Academic Research Consortium-2 classification. A sensitivity analysis was performed at 45 days., Results: A total of 121 (7.3%) patients experienced early nonprocedural bleeding events, and 69 (57.0%) were classified as major bleeding (4.2% of patients). Independent predictors of early nonprocedural bleeding were dual antiplatelet therapy (DAPT) at discharge (adjusted HR [aHR]: 1.61; 95% CI: 1.12-2.33; P = 0.01), prior gastrointestinal bleeding (aHR: 2.15; 95% CI: 1.38-3.35; P < 0.001), and multiple locations of prior bleeding (aHR: 2.33; 95% CI: 1.34-4.05; P < 0.001). DAPT at discharge was predictive of both all and major nonprocedural bleeding at 3 months and 45 days. After a median follow-up of 2.3 years (Q1-Q3: 1.1-4.1 years), early nonprocedural bleeding was independently associated with an increased risk of all-cause death (aHR: 1.53; 95% CI: 1.15-2.06; P < 0.001). This heightened mortality risk was similar at 45 days., Conclusions: Early nonprocedural bleeding after LAAO occurred in ∼7% of patients within 3 months, with more than one-half being classified as major bleeding. Regardless of severity, early nonprocedural bleeding was associated with increased mortality. DAPT at discharge determined an increased risk of early nonprocedural bleeding after LAAO. These results emphasize the importance of bleeding risk for determining antithrombotic strategies after LAAO., Competing Interests: Funding Support and Author Disclosures Dr Cruz-González is proctor for Boston Scientific, Abbott, and Lifetech. Dr Nombela-Franco is proctor for Abbott. Dr Rodés-Cabau holds the research chair “fondation famille Jacques Larivière” for the development of structural heart interventions (Laval University), and has received institutional research grants from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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