Major bleeding predictors in patients with left atrial appendage closure: The iberian registry II

Introduction and objective: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in di erent series. This study aimed to clarify the bleeding predictive factors that could influence these di erences. Methods: LAAC was performe...

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Autores: López-Mínguez, José Ramón, Nogales-Asensio, Juan Manuel, De Oliveira, Eduardo Infante, Santos, Lino, Ruiz-Salmerón, Rafael, Arzamendi-Aizpurua, Dabit, Costa, Marco, Gutiérrez-García, Hipólito, Fernández-Díaz, José Antonio, Freixa, Xavier, Cruz-González, Ignacio, Moreno Gómez, José Raúl, Íñiguez-Romo, Andrés, Alfonso Manterola, Fernando
Tipo de recurso: artículo
Fecha de publicación:2020
País:España
Institución:Universidad Autónoma de Madrid
Repositorio:Biblos-e Archivo. Repositorio Institucional de la UAM
Idioma:inglés
OAI Identifier:oai:repositorio.uam.es:10486/696481
Acceso en línea:http://hdl.handle.net/10486/696481
https://dx.doi.org/10.3390/jcm9072295
Access Level:acceso abierto
Palabra clave:atrial fibrillation
bleeding risk
age
left atrial appendage closure
Medicina
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spelling Major bleeding predictors in patients with left atrial appendage closure: The iberian registry IILópez-Mínguez, José RamónNogales-Asensio, Juan ManuelDe Oliveira, Eduardo InfanteSantos, LinoRuiz-Salmerón, RafaelArzamendi-Aizpurua, DabitCosta, MarcoGutiérrez-García, HipólitoFernández-Díaz, José AntonioFreixa, XavierCruz-González, IgnacioMoreno Gómez, José RaúlÍñiguez-Romo, AndrésAlfonso Manterola, Fernandoatrial fibrillationbleeding riskageleft atrial appendage closureMedicinaIntroduction and objective: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in di erent series. This study aimed to clarify the bleeding predictive factors that could influence these di erences. Methods: LAAC was performed in 598 patients from the Iberian Registry II (1093 patient-years; median, 75.4 years). We conducted a multivariate analysis to identify predictive risk factors for major bleeding events. The occurrence of thromboembolic and bleeding events was compared to rates expected from CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drugs or alcohol) scores. Results: Cox regression analysis revealed that age 75 years (HR: 2.5; 95% CI: 1.3 to 4.8; p = 0.004) and a history of gastrointestinal bleeding (GIB) (HR: 2.1; 95% CI: 1.1 to 3.9; p = 0.020) were two factors independently associated with major bleeding during follow-up. Patients aged <75 or 75 years had median CHA2DS2-VASc scores of 4 (IQR: 2) and 5 (IQR: 2), respectively (p < 0.001) and HAS-BLED scores were 3 (IQR: 1) and 3 (IQR: 1) for each group (p = 0.007). Events presented as follow-up adjusted rates according to age groups were stroke (1.2% vs. 2.9%; HR: 2.4, p = 0.12) and major bleeding (3.7 vs. 9.0 per 100 patient-years; HR: 2.4, p = 0.002). Expected major bleedings according to HAS-BLED scores were 6.2% vs. 6.6%, respectively. In patients with GIB history, major bleeding events were 6.1% patient-years (HAS-BLED score was 3.8 1.1) compared to 2.7% patients-year in patients with no previous GIB history (HAS-BLED score was 3.4 1.2; p = 0.029). Conclusions: In this high-risk population, GIB history and age 75 years are the main predictors of major bleeding events after LAAC, especially during the first year. Age seems to have a greater influence on major bleeding events than on thromboembolic risk in these patientsMDPI, Basel, SwitzerlandDepartamento de MedicinaFacultad de MedicinaInstituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP)20202020-07-19research articlehttp://purl.org/coar/resource_type/c_2df8fbb1VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10486/696481https://dx.doi.org/10.3390/jcm9072295reponame:Biblos-e Archivo. Repositorio Institucional de la UAMinstname:Universidad Autónoma de MadridInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:repositorio.uam.es:10486/6964812026-06-23T12:46:27Z
dc.title.none.fl_str_mv Major bleeding predictors in patients with left atrial appendage closure: The iberian registry II
title Major bleeding predictors in patients with left atrial appendage closure: The iberian registry II
spellingShingle Major bleeding predictors in patients with left atrial appendage closure: The iberian registry II
López-Mínguez, José Ramón
atrial fibrillation
bleeding risk
age
left atrial appendage closure
Medicina
title_short Major bleeding predictors in patients with left atrial appendage closure: The iberian registry II
title_full Major bleeding predictors in patients with left atrial appendage closure: The iberian registry II
title_fullStr Major bleeding predictors in patients with left atrial appendage closure: The iberian registry II
title_full_unstemmed Major bleeding predictors in patients with left atrial appendage closure: The iberian registry II
title_sort Major bleeding predictors in patients with left atrial appendage closure: The iberian registry II
dc.creator.none.fl_str_mv López-Mínguez, José Ramón
Nogales-Asensio, Juan Manuel
De Oliveira, Eduardo Infante
Santos, Lino
Ruiz-Salmerón, Rafael
Arzamendi-Aizpurua, Dabit
Costa, Marco
Gutiérrez-García, Hipólito
Fernández-Díaz, José Antonio
Freixa, Xavier
Cruz-González, Ignacio
Moreno Gómez, José Raúl
Íñiguez-Romo, Andrés
Alfonso Manterola, Fernando
author López-Mínguez, José Ramón
author_facet López-Mínguez, José Ramón
Nogales-Asensio, Juan Manuel
De Oliveira, Eduardo Infante
Santos, Lino
Ruiz-Salmerón, Rafael
Arzamendi-Aizpurua, Dabit
Costa, Marco
Gutiérrez-García, Hipólito
Fernández-Díaz, José Antonio
Freixa, Xavier
Cruz-González, Ignacio
Moreno Gómez, José Raúl
Íñiguez-Romo, Andrés
Alfonso Manterola, Fernando
author_role author
author2 Nogales-Asensio, Juan Manuel
De Oliveira, Eduardo Infante
Santos, Lino
Ruiz-Salmerón, Rafael
Arzamendi-Aizpurua, Dabit
Costa, Marco
Gutiérrez-García, Hipólito
Fernández-Díaz, José Antonio
Freixa, Xavier
Cruz-González, Ignacio
Moreno Gómez, José Raúl
Íñiguez-Romo, Andrés
Alfonso Manterola, Fernando
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Departamento de Medicina
Facultad de Medicina
Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP)
dc.subject.none.fl_str_mv atrial fibrillation
bleeding risk
age
left atrial appendage closure
Medicina
topic atrial fibrillation
bleeding risk
age
left atrial appendage closure
Medicina
description Introduction and objective: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in di erent series. This study aimed to clarify the bleeding predictive factors that could influence these di erences. Methods: LAAC was performed in 598 patients from the Iberian Registry II (1093 patient-years; median, 75.4 years). We conducted a multivariate analysis to identify predictive risk factors for major bleeding events. The occurrence of thromboembolic and bleeding events was compared to rates expected from CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drugs or alcohol) scores. Results: Cox regression analysis revealed that age 75 years (HR: 2.5; 95% CI: 1.3 to 4.8; p = 0.004) and a history of gastrointestinal bleeding (GIB) (HR: 2.1; 95% CI: 1.1 to 3.9; p = 0.020) were two factors independently associated with major bleeding during follow-up. Patients aged <75 or 75 years had median CHA2DS2-VASc scores of 4 (IQR: 2) and 5 (IQR: 2), respectively (p < 0.001) and HAS-BLED scores were 3 (IQR: 1) and 3 (IQR: 1) for each group (p = 0.007). Events presented as follow-up adjusted rates according to age groups were stroke (1.2% vs. 2.9%; HR: 2.4, p = 0.12) and major bleeding (3.7 vs. 9.0 per 100 patient-years; HR: 2.4, p = 0.002). Expected major bleedings according to HAS-BLED scores were 6.2% vs. 6.6%, respectively. In patients with GIB history, major bleeding events were 6.1% patient-years (HAS-BLED score was 3.8 1.1) compared to 2.7% patients-year in patients with no previous GIB history (HAS-BLED score was 3.4 1.2; p = 0.029). Conclusions: In this high-risk population, GIB history and age 75 years are the main predictors of major bleeding events after LAAC, especially during the first year. Age seems to have a greater influence on major bleeding events than on thromboembolic risk in these patients
publishDate 2020
dc.date.none.fl_str_mv 2020
2020-07-19
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/10486/696481
https://dx.doi.org/10.3390/jcm9072295
url http://hdl.handle.net/10486/696481
https://dx.doi.org/10.3390/jcm9072295
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
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
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv MDPI, Basel, Switzerland
publisher.none.fl_str_mv MDPI, Basel, Switzerland
dc.source.none.fl_str_mv reponame:Biblos-e Archivo. Repositorio Institucional de la UAM
instname:Universidad Autónoma de Madrid
instname_str Universidad Autónoma de Madrid
reponame_str Biblos-e Archivo. Repositorio Institucional de la UAM
collection Biblos-e Archivo. Repositorio Institucional de la UAM
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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