Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing

BACKGROUND: Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and CHADS-VASc ≥2. Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scarce and the timing...

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Autores: Gonzalez-Calle, D, Nombela-Franco, L, Gutierrez-Garcia, H, Peral Disdier, Vicente, Mesnier, J, Tirado-Conde, G, Barrero-Mier, A, Morcuende Gonzalez, A, O'Hara, G, López-Mesonero, L, Salinas, P, Sanchís, L, Cepas-Guillén, P, Laffond, A, Freixa, X, Amat-Santos, I, Sanchez, P L, Rodes-Cabau, J, Cruz-Gonzalez, I
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:docusalut.com:20.500.13003/25898
Acceso en línea:https://hdl.handle.net/20.500.13003/25898
Access Level:acceso abierto
Palabra clave:Atrial Fibrillation
Left Atrial Appendage Closure
Intracranial Hemorrhages
Fibrilación Atrial
Cierre del Apéndice Auricular Izquierdo
Hemorragias Intracraneales
Atrial fibrillation
Cierre percutáneo de orejuela izquierda
Fibrilación auricular
Hemorragia intracranial
Intracranial hemorrhage
Left atrial appendage occlusion
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spelling Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timingGonzalez-Calle, DNombela-Franco, LGutierrez-Garcia, HPeral Disdier, VicenteMesnier, JTirado-Conde, GBarrero-Mier, AMorcuende Gonzalez, AO'Hara, GLópez-Mesonero, LSalinas, PSanchís, LCepas-Guillén, PLaffond, AFreixa, XAmat-Santos, ISanchez, P LRodes-Cabau, JCruz-Gonzalez, IAtrial FibrillationLeft Atrial Appendage ClosureIntracranial HemorrhagesFibrilación AtrialCierre del Apéndice Auricular IzquierdoHemorragias IntracranealesAtrial fibrillationCierre percutáneo de orejuela izquierdaFibrilación auricularHemorragia intracranialIntracranial hemorrhageLeft atrial appendage occlusionBACKGROUND: Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and CHADS-VASc ≥2. Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scarce and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described previously. OBJECTIVE: To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHADS-VASc ≥2) and to determine adequate timing of its performance. METHODS: This is a multicenter retrospective registry that included 128 patients, whose indication for this procedure was ICH. Patients were divided into two groups: early occlusion (n=31; 24.2%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (n=97; 75.8%), after 90 days. RESULTS: Global procedural success was of 97% (124/128). Procedure-related complications occurred in 4 patients (3.15%): 2 cardiac tamponade, 1 device embolization and 1 transient ischemic attack during hospitalization. There was a significant reduction in the ischemic and bleeding rates compared to expected based on CHADS-VASc and HASBLED scores (93.9% and 89.9% respectively) after a mean follow-up of 73.9±34.1 months. There were no significant differences neither in baseline characteristics between the early and late occlusion groups nor in the procedural success or complications rates. Furthermore, no statistically significant differences were found in mortality, ischemic events, or hemorrhage between the early and late occlusion group. CONCLUSIONS: Left atrial appendage occlusion is an effective and safe treatment alternative to reduce the risk of ischemic stroke in selected patients with atrial fibrillation and prior intracranial hemorrhage. In this study, we did not find differences regarding safety and efficacy in early closure compared with late closure. Further studies are needed to support early closure to reduce the complications associated with oral anticoagulation withdrawal.Elsevier20252025-01-0120252025-01-01research articlehttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.13003/25898reponame:Docusalutinstname:Conselleria de Salut i Consum del Govern de les Illes BalearsInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:docusalut.com:20.500.13003/258982026-06-22T12:44:07Z
dc.title.none.fl_str_mv Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing
title Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing
spellingShingle Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing
Gonzalez-Calle, D
Atrial Fibrillation
Left Atrial Appendage Closure
Intracranial Hemorrhages
Fibrilación Atrial
Cierre del Apéndice Auricular Izquierdo
Hemorragias Intracraneales
Atrial fibrillation
Cierre percutáneo de orejuela izquierda
Fibrilación auricular
Hemorragia intracranial
Intracranial hemorrhage
Left atrial appendage occlusion
title_short Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing
title_full Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing
title_fullStr Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing
title_full_unstemmed Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing
title_sort Left atrial appendage closure in patients with prior intracranial bleeding, safety, efficacy, and timing
dc.creator.none.fl_str_mv Gonzalez-Calle, D
Nombela-Franco, L
Gutierrez-Garcia, H
Peral Disdier, Vicente
Mesnier, J
Tirado-Conde, G
Barrero-Mier, A
Morcuende Gonzalez, A
O'Hara, G
López-Mesonero, L
Salinas, P
Sanchís, L
Cepas-Guillén, P
Laffond, A
Freixa, X
Amat-Santos, I
Sanchez, P L
Rodes-Cabau, J
Cruz-Gonzalez, I
author Gonzalez-Calle, D
author_facet Gonzalez-Calle, D
Nombela-Franco, L
Gutierrez-Garcia, H
Peral Disdier, Vicente
Mesnier, J
Tirado-Conde, G
Barrero-Mier, A
Morcuende Gonzalez, A
O'Hara, G
López-Mesonero, L
Salinas, P
Sanchís, L
Cepas-Guillén, P
Laffond, A
Freixa, X
Amat-Santos, I
Sanchez, P L
Rodes-Cabau, J
Cruz-Gonzalez, I
author_role author
author2 Nombela-Franco, L
Gutierrez-Garcia, H
Peral Disdier, Vicente
Mesnier, J
Tirado-Conde, G
Barrero-Mier, A
Morcuende Gonzalez, A
O'Hara, G
López-Mesonero, L
Salinas, P
Sanchís, L
Cepas-Guillén, P
Laffond, A
Freixa, X
Amat-Santos, I
Sanchez, P L
Rodes-Cabau, J
Cruz-Gonzalez, I
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv Atrial Fibrillation
Left Atrial Appendage Closure
Intracranial Hemorrhages
Fibrilación Atrial
Cierre del Apéndice Auricular Izquierdo
Hemorragias Intracraneales
Atrial fibrillation
Cierre percutáneo de orejuela izquierda
Fibrilación auricular
Hemorragia intracranial
Intracranial hemorrhage
Left atrial appendage occlusion
topic Atrial Fibrillation
Left Atrial Appendage Closure
Intracranial Hemorrhages
Fibrilación Atrial
Cierre del Apéndice Auricular Izquierdo
Hemorragias Intracraneales
Atrial fibrillation
Cierre percutáneo de orejuela izquierda
Fibrilación auricular
Hemorragia intracranial
Intracranial hemorrhage
Left atrial appendage occlusion
description BACKGROUND: Oral anticoagulation (OAC) use increases the risk of intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF) and CHADS-VASc ≥2. Left atrial appendage occlusion (LAAO) is an alternative to OAC, however data about its use in patients with prior ICH is scarce and the timing of its performance is controversial. Furthermore, the long-term outcomes in this group of patients have not been described previously. OBJECTIVE: To evaluate the safety and efficacy of LAAO in patients with non-valvular AF and prior ICH (CHADS-VASc ≥2) and to determine adequate timing of its performance. METHODS: This is a multicenter retrospective registry that included 128 patients, whose indication for this procedure was ICH. Patients were divided into two groups: early occlusion (n=31; 24.2%), in which the procedure was performed before 90 days had elapsed after the bleeding, and late occlusion (n=97; 75.8%), after 90 days. RESULTS: Global procedural success was of 97% (124/128). Procedure-related complications occurred in 4 patients (3.15%): 2 cardiac tamponade, 1 device embolization and 1 transient ischemic attack during hospitalization. There was a significant reduction in the ischemic and bleeding rates compared to expected based on CHADS-VASc and HASBLED scores (93.9% and 89.9% respectively) after a mean follow-up of 73.9±34.1 months. There were no significant differences neither in baseline characteristics between the early and late occlusion groups nor in the procedural success or complications rates. Furthermore, no statistically significant differences were found in mortality, ischemic events, or hemorrhage between the early and late occlusion group. CONCLUSIONS: Left atrial appendage occlusion is an effective and safe treatment alternative to reduce the risk of ischemic stroke in selected patients with atrial fibrillation and prior intracranial hemorrhage. In this study, we did not find differences regarding safety and efficacy in early closure compared with late closure. Further studies are needed to support early closure to reduce the complications associated with oral anticoagulation withdrawal.
publishDate 2025
dc.date.none.fl_str_mv 2025
2025-01-01
2025
2025-01-01
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.13003/25898
url https://hdl.handle.net/20.500.13003/25898
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Docusalut
instname:Conselleria de Salut i Consum del Govern de les Illes Balears
instname_str Conselleria de Salut i Consum del Govern de les Illes Balears
reponame_str Docusalut
collection Docusalut
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,81155

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