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Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective
Background: Left atrial appendage occlusion is an increasingly proposed treatment for patients with atrial fibrillation and poor tolerance to anticoagulants. All endovascular devices require antithrombotic therapy. Anatomical and clinical variables predisposing to device-related thrombosis, as well...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9656641/ https://www.ncbi.nlm.nih.gov/pubmed/36362719 http://dx.doi.org/10.3390/jcm11216492 |
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author | Branzoli, Stefano Guarracini, Fabrizio Marini, Massimiliano D’Onghia, Giovanni Catanzariti, Domenico Merola, Elettra Annicchiarico, Luciano Casagranda, Giulia Stegagno, Chiara Fantinel, Mauro La Meir, Mark |
author_facet | Branzoli, Stefano Guarracini, Fabrizio Marini, Massimiliano D’Onghia, Giovanni Catanzariti, Domenico Merola, Elettra Annicchiarico, Luciano Casagranda, Giulia Stegagno, Chiara Fantinel, Mauro La Meir, Mark |
author_sort | Branzoli, Stefano |
collection | PubMed |
description | Background: Left atrial appendage occlusion is an increasingly proposed treatment for patients with atrial fibrillation and poor tolerance to anticoagulants. All endovascular devices require antithrombotic therapy. Anatomical and clinical variables predisposing to device-related thrombosis, as well as post-procedural peri-device leaks, could mandate the continuation or reintroduction of aggressive antithrombotic treatment. Because of the absence of foreign material inside the heart, epicardial appendage closure possibly does not necessitate antithrombotic therapy, but data of large series are missing. Methods: Multidisciplinary team evaluation for standalone totally thoracoscopic epicardial appendage closure was done in 180 consecutive patients with atrial fibrillation and poor tolerance to antithrombotic therapy. One hundred and fifty-two patients consented (male 66.1%, mean age 76.1 ± 7.4, CHA(2)DS(2)VASc mean 5.3 ± 1.6, HASBLED mean 3.8 ± 1.1). Indications were cerebral hemorrhage (48%), gastro-intestinal bleeding (33.3%), and other bleeding (20.7%). No antithrombotic therapy was prescribed from the day of surgery to the latest follow up. Results: Procedural success was 98.7%. At a mean follow up of 38.2 ± 18.8 months, cardioembolic and bleeding events were 1.3% and 0.6%, respectively. Among patients with a history of blood transfusions (41.1%), none needed further transfusions or treatment post procedure. Conclusion: Epicardial appendage occlusion without any antithrombotic therapy appears to be safe and effective. This strategy could be advised when minimization of bleeding risk concomitant to stroke prevention is needed. |
format | Online Article Text |
id | pubmed-9656641 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-96566412022-11-15 Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective Branzoli, Stefano Guarracini, Fabrizio Marini, Massimiliano D’Onghia, Giovanni Catanzariti, Domenico Merola, Elettra Annicchiarico, Luciano Casagranda, Giulia Stegagno, Chiara Fantinel, Mauro La Meir, Mark J Clin Med Article Background: Left atrial appendage occlusion is an increasingly proposed treatment for patients with atrial fibrillation and poor tolerance to anticoagulants. All endovascular devices require antithrombotic therapy. Anatomical and clinical variables predisposing to device-related thrombosis, as well as post-procedural peri-device leaks, could mandate the continuation or reintroduction of aggressive antithrombotic treatment. Because of the absence of foreign material inside the heart, epicardial appendage closure possibly does not necessitate antithrombotic therapy, but data of large series are missing. Methods: Multidisciplinary team evaluation for standalone totally thoracoscopic epicardial appendage closure was done in 180 consecutive patients with atrial fibrillation and poor tolerance to antithrombotic therapy. One hundred and fifty-two patients consented (male 66.1%, mean age 76.1 ± 7.4, CHA(2)DS(2)VASc mean 5.3 ± 1.6, HASBLED mean 3.8 ± 1.1). Indications were cerebral hemorrhage (48%), gastro-intestinal bleeding (33.3%), and other bleeding (20.7%). No antithrombotic therapy was prescribed from the day of surgery to the latest follow up. Results: Procedural success was 98.7%. At a mean follow up of 38.2 ± 18.8 months, cardioembolic and bleeding events were 1.3% and 0.6%, respectively. Among patients with a history of blood transfusions (41.1%), none needed further transfusions or treatment post procedure. Conclusion: Epicardial appendage occlusion without any antithrombotic therapy appears to be safe and effective. This strategy could be advised when minimization of bleeding risk concomitant to stroke prevention is needed. MDPI 2022-11-01 /pmc/articles/PMC9656641/ /pubmed/36362719 http://dx.doi.org/10.3390/jcm11216492 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Branzoli, Stefano Guarracini, Fabrizio Marini, Massimiliano D’Onghia, Giovanni Catanzariti, Domenico Merola, Elettra Annicchiarico, Luciano Casagranda, Giulia Stegagno, Chiara Fantinel, Mauro La Meir, Mark Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective |
title | Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective |
title_full | Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective |
title_fullStr | Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective |
title_full_unstemmed | Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective |
title_short | Heart Team for Left Appendage Occlusion without the Use of Antithrombotic Therapy: The Epicardial Perspective |
title_sort | heart team for left appendage occlusion without the use of antithrombotic therapy: the epicardial perspective |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9656641/ https://www.ncbi.nlm.nih.gov/pubmed/36362719 http://dx.doi.org/10.3390/jcm11216492 |
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