Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication

Aarnink, E.W.|||0000-0002-0189-8647; Beneduce, A.|||0000-0003-2130-1964; Gasperetti, Alessio|||0000-0003-3432-070X; Pracon, R.|||0000-0001-7519-0003; Estevez-Loureiro, Rodrigo|||0000-0001-5841-5514; Benito-González, Tomás|||0000-0002-8428-9248; Nombela-Franco, Luís|||0000-0003-3438-8907; Arzamendi, Dabit|||0000-0001-7543-5867; Freixa, Xavier|||0000-0002-3203-9060; Adamo, Marianna|||0000-0002-3855-1815; Suradi, H.S.|||0000-0001-6012-9648; Peper, J.|||0000-0002-4008-1656; Maarse, Moniek; Fierro, Nicolai; Mazzone, P.; Tondo, Claudio|||0000-0002-8500-8313; Demkow, M.; Zieliński, K.; De Backer, Ole|||0000-0002-9674-0278; Korsholm, K.; Nielsen-Kudsk, J.E.; Caneiro-Queija, B.; Pérez de Prado, Armando; Salinas, Pablo|||0000-0003-4040-4029; Holmes, D.; Almakadma, A.H.; Berti, Sergio; Romeo, M.R.; Millán, Xavier|||0000-0001-6519-4190; Alla, V.M.; Agarwal, H.; Eitel, I.; Paitazoglou, C.; Cepas-Guillén, Pedro|||0000-0001-8814-7039; Chothia, R.; Badejoko, S.O.; Spoon, D.B.; Maddux, J.T.; El-Chami, M.; Ram, P.; Branca, L.; van Dijk, V.F.; Rensing, B.J.W.M.; Swaans, M.J.; Vireca, E.; Bergmann, M.W.; Boersma, L.V.A.

Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication

Background: Left atrial appendage occlusion (LAAO) provides mechanical cardioembolic protection for atrial fibrillation (AF) patients who cannot use oral anticoagulation therapy (OAT). Patients with a thrombotic event despite OAT are at high risk for recurrence and may also benefit from LAAO. Object...

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Autores:	Aarnink, E.W.\|\|\|0000-0002-0189-8647, Beneduce, A.\|\|\|0000-0003-2130-1964, Gasperetti, Alessio\|\|\|0000-0003-3432-070X, Pracon, R.\|\|\|0000-0001-7519-0003, Estevez-Loureiro, Rodrigo\|\|\|0000-0001-5841-5514, Benito-González, Tomás\|\|\|0000-0002-8428-9248, Nombela-Franco, Luís\|\|\|0000-0003-3438-8907, Arzamendi, Dabit\|\|\|0000-0001-7543-5867, Freixa, Xavier\|\|\|0000-0002-3203-9060, Adamo, Marianna\|\|\|0000-0002-3855-1815, Suradi, H.S.\|\|\|0000-0001-6012-9648, Peper, J.\|\|\|0000-0002-4008-1656, Maarse, Moniek, Fierro, Nicolai, Mazzone, P., Tondo, Claudio\|\|\|0000-0002-8500-8313, Demkow, M., Zieliński, K., De Backer, Ole\|\|\|0000-0002-9674-0278, Korsholm, K., Nielsen-Kudsk, J.E., Caneiro-Queija, B., Pérez de Prado, Armando, Salinas, Pablo\|\|\|0000-0003-4040-4029, Holmes, D., Almakadma, A.H., Berti, Sergio, Romeo, M.R., Millán, Xavier\|\|\|0000-0001-6519-4190, Alla, V.M., Agarwal, H., Eitel, I., Paitazoglou, C., Cepas-Guillén, Pedro\|\|\|0000-0001-8814-7039, Chothia, R., Badejoko, S.O., Spoon, D.B., Maddux, J.T., El-Chami, M., Ram, P., Branca, L., van Dijk, V.F., Rensing, B.J.W.M., Swaans, M.J., Vireca, E., Bergmann, M.W., Boersma, L.V.A.
Formato:	artículo
Fecha de publicación:	2024
País:	España
Recursos:	Universitat Autònoma de Barcelona
Repositorio:	Dipòsit Digital de Documents de la UAB
Idioma:	inglés
OAI Identifier:	oai:ddd.uab.cat:324020
Acesso em linha:	https://ddd.uab.cat/record/324020 https://dx.doi.org/urn:doi:10.1016/j.jcin.2024.04.012
Access Level:	acceso abierto
Palavra-chave:	Anticoagulation failure Atrial fibrillation Ischemic stroke Left atrial appendage occlusion

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oai_identifier_str	oai:ddd.uab.cat:324020
network_acronym_str	ES
network_name_str	España
repository_id_str
dc.title.none.fl_str_mv	Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication
title	Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication
spellingShingle	Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication Aarnink, E.W.\|\|\|0000-0002-0189-8647 Anticoagulation failure Atrial fibrillation Ischemic stroke Left atrial appendage occlusion
title_short	Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication
title_full	Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication
title_fullStr	Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication
title_full_unstemmed	Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication
title_sort	Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication
dc.creator.none.fl_str_mv	Aarnink, E.W.\|\|\|0000-0002-0189-8647 Beneduce, A.\|\|\|0000-0003-2130-1964 Gasperetti, Alessio\|\|\|0000-0003-3432-070X Pracon, R.\|\|\|0000-0001-7519-0003 Estevez-Loureiro, Rodrigo\|\|\|0000-0001-5841-5514 Benito-González, Tomás\|\|\|0000-0002-8428-9248 Nombela-Franco, Luís\|\|\|0000-0003-3438-8907 Arzamendi, Dabit\|\|\|0000-0001-7543-5867 Freixa, Xavier\|\|\|0000-0002-3203-9060 Adamo, Marianna\|\|\|0000-0002-3855-1815 Suradi, H.S.\|\|\|0000-0001-6012-9648 Peper, J.\|\|\|0000-0002-4008-1656 Maarse, Moniek Fierro, Nicolai Mazzone, P. Tondo, Claudio\|\|\|0000-0002-8500-8313 Demkow, M. Zieliński, K. De Backer, Ole\|\|\|0000-0002-9674-0278 Korsholm, K. Nielsen-Kudsk, J.E. Caneiro-Queija, B. Pérez de Prado, Armando Salinas, Pablo\|\|\|0000-0003-4040-4029 Holmes, D. Almakadma, A.H. Berti, Sergio Romeo, M.R. Millán, Xavier\|\|\|0000-0001-6519-4190 Alla, V.M. Agarwal, H. Eitel, I. Paitazoglou, C. Cepas-Guillén, Pedro\|\|\|0000-0001-8814-7039 Chothia, R. Badejoko, S.O. Spoon, D.B. Maddux, J.T. El-Chami, M. Ram, P. Branca, L. van Dijk, V.F. Rensing, B.J.W.M. Swaans, M.J. Vireca, E. Bergmann, M.W. Boersma, L.V.A.
author	Aarnink, E.W.\|\|\|0000-0002-0189-8647
author_facet	Aarnink, E.W.\|\|\|0000-0002-0189-8647 Beneduce, A.\|\|\|0000-0003-2130-1964 Gasperetti, Alessio\|\|\|0000-0003-3432-070X Pracon, R.\|\|\|0000-0001-7519-0003 Estevez-Loureiro, Rodrigo\|\|\|0000-0001-5841-5514 Benito-González, Tomás\|\|\|0000-0002-8428-9248 Nombela-Franco, Luís\|\|\|0000-0003-3438-8907 Arzamendi, Dabit\|\|\|0000-0001-7543-5867 Freixa, Xavier\|\|\|0000-0002-3203-9060 Adamo, Marianna\|\|\|0000-0002-3855-1815 Suradi, H.S.\|\|\|0000-0001-6012-9648 Peper, J.\|\|\|0000-0002-4008-1656 Maarse, Moniek Fierro, Nicolai Mazzone, P. Tondo, Claudio\|\|\|0000-0002-8500-8313 Demkow, M. Zieliński, K. De Backer, Ole\|\|\|0000-0002-9674-0278 Korsholm, K. Nielsen-Kudsk, J.E. Caneiro-Queija, B. Pérez de Prado, Armando Salinas, Pablo\|\|\|0000-0003-4040-4029 Holmes, D. Almakadma, A.H. Berti, Sergio Romeo, M.R. Millán, Xavier\|\|\|0000-0001-6519-4190 Alla, V.M. Agarwal, H. Eitel, I. Paitazoglou, C. Cepas-Guillén, Pedro\|\|\|0000-0001-8814-7039 Chothia, R. Badejoko, S.O. Spoon, D.B. Maddux, J.T. El-Chami, M. Ram, P. Branca, L. van Dijk, V.F. Rensing, B.J.W.M. Swaans, M.J. Vireca, E. Bergmann, M.W. Boersma, L.V.A.
author_role	author
author2	Beneduce, A.\|\|\|0000-0003-2130-1964 Gasperetti, Alessio\|\|\|0000-0003-3432-070X Pracon, R.\|\|\|0000-0001-7519-0003 Estevez-Loureiro, Rodrigo\|\|\|0000-0001-5841-5514 Benito-González, Tomás\|\|\|0000-0002-8428-9248 Nombela-Franco, Luís\|\|\|0000-0003-3438-8907 Arzamendi, Dabit\|\|\|0000-0001-7543-5867 Freixa, Xavier\|\|\|0000-0002-3203-9060 Adamo, Marianna\|\|\|0000-0002-3855-1815 Suradi, H.S.\|\|\|0000-0001-6012-9648 Peper, J.\|\|\|0000-0002-4008-1656 Maarse, Moniek Fierro, Nicolai Mazzone, P. Tondo, Claudio\|\|\|0000-0002-8500-8313 Demkow, M. Zieliński, K. De Backer, Ole\|\|\|0000-0002-9674-0278 Korsholm, K. Nielsen-Kudsk, J.E. Caneiro-Queija, B. Pérez de Prado, Armando Salinas, Pablo\|\|\|0000-0003-4040-4029 Holmes, D. Almakadma, A.H. Berti, Sergio Romeo, M.R. Millán, Xavier\|\|\|0000-0001-6519-4190 Alla, V.M. Agarwal, H. Eitel, I. Paitazoglou, C. Cepas-Guillén, Pedro\|\|\|0000-0001-8814-7039 Chothia, R. Badejoko, S.O. Spoon, D.B. Maddux, J.T. El-Chami, M. Ram, P. Branca, L. van Dijk, V.F. Rensing, B.J.W.M. Swaans, M.J. Vireca, E. Bergmann, M.W. Boersma, L.V.A.
author2_role	author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author
dc.contributor.none.fl_str_mv	Universitat Autònoma de Barcelona. Departament de Medicina
dc.subject.none.fl_str_mv	Anticoagulation failure Atrial fibrillation Ischemic stroke Left atrial appendage occlusion
topic	Anticoagulation failure Atrial fibrillation Ischemic stroke Left atrial appendage occlusion
description	Background: Left atrial appendage occlusion (LAAO) provides mechanical cardioembolic protection for atrial fibrillation (AF) patients who cannot use oral anticoagulation therapy (OAT). Patients with a thrombotic event despite OAT are at high risk for recurrence and may also benefit from LAAO. Objectives: This study sought to investigate the efficacy of LAAO in AF patients with a thrombotic event on OAT compared to: 1) LAAO in AF patients with a contraindication for OAT; and 2) historical data. Methods: The international LAAO after stroke despite oral anticoagulation (STR-OAC LAAO) collaboration included patients who underwent LAAO because of thrombotic events on OAT. This cohort underwent propensity score matching and was compared to the EWOLUTION (Evaluating Real-Life Clinical Outcomes in Atrial Fibrillation Patients Receiving the WATCHMAN Left Atrial Appendage Closure Technology) registry, which represents patients who underwent LAAO because of OAT contraindications. The primary outcome was ischemic stroke. Event rates were compared between cohorts and with historical data without OAT, yielding relative risk reductions based on risk scores. Results: Analysis of 438 matched pairs revealed no significant difference in the ischemic stroke rate between the STR-OAC LAAO and EWOLUTION cohorts (2.5% vs 1.9%; HR: 1.37; 95% CI: 0.72-2.61). STR-OAC LAAO patients exhibited a higher thromboembolic risk (HR: 1.71; 95% CI: 1.04-2.83) but lower bleeding risk (HR: 0.39; 95% CI: 0.18-0.88) compared to EWOLUTION patients. The mortality rate was slightly higher in EWOLUTION (4.3% vs 6.9%; log-rank P = 0.028). Relative risk reductions for ischemic stroke were 70% and 78% in STR-OAC LAAO and EWOLUTION, respectively, compared to historical data without OAT. Conclusions: LAAO in patients with a thrombotic event on OAT demonstrated comparable stroke rates to the OAT contraindicated population in EWOLUTION. The thromboembolic event rate was higher and the bleeding rate lower, reflecting the intrinsically different risk profile of both populations. Until randomized trials are available, LAAO may be considered in patients with an ischemic event on OAT.
publishDate	2024
dc.date.none.fl_str_mv	2 2024-01-01 2024 2024-01-01
dc.type.none.fl_str_mv	Article http://purl.org/coar/resource_type/c_6501 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	https://ddd.uab.cat/record/324020 https://dx.doi.org/urn:doi:10.1016/j.jcin.2024.04.012
url	https://ddd.uab.cat/record/324020 https://dx.doi.org/urn:doi:10.1016/j.jcin.2024.04.012
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 https://creativecommons.org/licenses/by/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 https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv	openAccess
dc.format.none.fl_str_mv	application/pdf
dc.source.none.fl_str_mv	reponame:Dipòsit Digital de Documents de la UAB instname:Universitat Autònoma de Barcelona
instname_str	Universitat Autònoma de Barcelona
reponame_str	Dipòsit Digital de Documents de la UAB
collection	Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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spelling	Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation ContraindicationAarnink, E.W.\|\|\|0000-0002-0189-8647Beneduce, A.\|\|\|0000-0003-2130-1964Gasperetti, Alessio\|\|\|0000-0003-3432-070XPracon, R.\|\|\|0000-0001-7519-0003Estevez-Loureiro, Rodrigo\|\|\|0000-0001-5841-5514Benito-González, Tomás\|\|\|0000-0002-8428-9248Nombela-Franco, Luís\|\|\|0000-0003-3438-8907Arzamendi, Dabit\|\|\|0000-0001-7543-5867Freixa, Xavier\|\|\|0000-0002-3203-9060Adamo, Marianna\|\|\|0000-0002-3855-1815Suradi, H.S.\|\|\|0000-0001-6012-9648Peper, J.\|\|\|0000-0002-4008-1656Maarse, MoniekFierro, NicolaiMazzone, P.Tondo, Claudio\|\|\|0000-0002-8500-8313Demkow, M.Zieliński, K.De Backer, Ole\|\|\|0000-0002-9674-0278Korsholm, K.Nielsen-Kudsk, J.E.Caneiro-Queija, B.Pérez de Prado, ArmandoSalinas, Pablo\|\|\|0000-0003-4040-4029Holmes, D.Almakadma, A.H.Berti, SergioRomeo, M.R.Millán, Xavier\|\|\|0000-0001-6519-4190Alla, V.M.Agarwal, H.Eitel, I.Paitazoglou, C.Cepas-Guillén, Pedro\|\|\|0000-0001-8814-7039Chothia, R.Badejoko, S.O.Spoon, D.B.Maddux, J.T.El-Chami, M.Ram, P.Branca, L.van Dijk, V.F.Rensing, B.J.W.M.Swaans, M.J.Vireca, E.Bergmann, M.W.Boersma, L.V.A.Anticoagulation failureAtrial fibrillationIschemic strokeLeft atrial appendage occlusionBackground: Left atrial appendage occlusion (LAAO) provides mechanical cardioembolic protection for atrial fibrillation (AF) patients who cannot use oral anticoagulation therapy (OAT). Patients with a thrombotic event despite OAT are at high risk for recurrence and may also benefit from LAAO. Objectives: This study sought to investigate the efficacy of LAAO in AF patients with a thrombotic event on OAT compared to: 1) LAAO in AF patients with a contraindication for OAT; and 2) historical data. Methods: The international LAAO after stroke despite oral anticoagulation (STR-OAC LAAO) collaboration included patients who underwent LAAO because of thrombotic events on OAT. This cohort underwent propensity score matching and was compared to the EWOLUTION (Evaluating Real-Life Clinical Outcomes in Atrial Fibrillation Patients Receiving the WATCHMAN Left Atrial Appendage Closure Technology) registry, which represents patients who underwent LAAO because of OAT contraindications. The primary outcome was ischemic stroke. Event rates were compared between cohorts and with historical data without OAT, yielding relative risk reductions based on risk scores. Results: Analysis of 438 matched pairs revealed no significant difference in the ischemic stroke rate between the STR-OAC LAAO and EWOLUTION cohorts (2.5% vs 1.9%; HR: 1.37; 95% CI: 0.72-2.61). STR-OAC LAAO patients exhibited a higher thromboembolic risk (HR: 1.71; 95% CI: 1.04-2.83) but lower bleeding risk (HR: 0.39; 95% CI: 0.18-0.88) compared to EWOLUTION patients. The mortality rate was slightly higher in EWOLUTION (4.3% vs 6.9%; log-rank P = 0.028). Relative risk reductions for ischemic stroke were 70% and 78% in STR-OAC LAAO and EWOLUTION, respectively, compared to historical data without OAT. Conclusions: LAAO in patients with a thrombotic event on OAT demonstrated comparable stroke rates to the OAT contraindicated population in EWOLUTION. The thromboembolic event rate was higher and the bleeding rate lower, reflecting the intrinsically different risk profile of both populations. Until randomized trials are available, LAAO may be considered in patients with an ischemic event on OAT.Universitat Autònoma de Barcelona. Departament de Medicina 22024-01-0120242024-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/324020https://dx.doi.org/urn:doi:10.1016/j.jcin.2024.04.012reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:3240202026-06-06T12:50:31Z
score	15,81155

Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication

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