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Incidence and Predictors of Clinically Significant Bleedings after Transcatheter Left Atrial Appendage Closure

Background: Transcatheter left atrial appendage closure (LAAC) is performed in patients unsuitable for long-term anticoagulation, predominantly due to prior bleeding events. The study aimed to investigate the incidence and predictors of clinically significant bleeding (CSB) post-LAAC. Methods: Conse...

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Autores principales: Zieliński, Kamil, Pracoń, Radosław, Konka, Marek, Kruk, Mariusz, Kępka, Cezary, Trochimiuk, Piotr, Dębski, Mariusz, Kaczmarska, Edyta, Przyłuski, Jakub, Kowalik, Ilona, Dzielińska, Zofia, Kurowski, Andrzej, Witkowski, Adam, Demkow, Marcin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9658798/
https://www.ncbi.nlm.nih.gov/pubmed/36360682
http://dx.doi.org/10.3390/ijerph192113802
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author Zieliński, Kamil
Pracoń, Radosław
Konka, Marek
Kruk, Mariusz
Kępka, Cezary
Trochimiuk, Piotr
Dębski, Mariusz
Kaczmarska, Edyta
Przyłuski, Jakub
Kowalik, Ilona
Dzielińska, Zofia
Kurowski, Andrzej
Witkowski, Adam
Demkow, Marcin
author_facet Zieliński, Kamil
Pracoń, Radosław
Konka, Marek
Kruk, Mariusz
Kępka, Cezary
Trochimiuk, Piotr
Dębski, Mariusz
Kaczmarska, Edyta
Przyłuski, Jakub
Kowalik, Ilona
Dzielińska, Zofia
Kurowski, Andrzej
Witkowski, Adam
Demkow, Marcin
author_sort Zieliński, Kamil
collection PubMed
description Background: Transcatheter left atrial appendage closure (LAAC) is performed in patients unsuitable for long-term anticoagulation, predominantly due to prior bleeding events. The study aimed to investigate the incidence and predictors of clinically significant bleeding (CSB) post-LAAC. Methods: Consecutive patients after LAAC with an Amplatzer or WATCHMAN device were analyzed (05.2014–11.2019). Bleeding was classified as CSB when associated with at least one of the following: death, ≥2 g/dL hemoglobin drop, ≥2 blood units transfusion, critical anatomic site, or hospitalization/invasive procedure. Results: Among 195 patients (age 74 (68–80), 43.1% females, HAS-BLED score 2.0 (2.0–3.0)), during median follow-up of 370 (IQR, 358–392) days, there were 15 nonprocedural CSBs in 14 (7.2%) patients. Of those, 9 (60.0%) occurred during postprocedural dual antiplatelet therapy (DAPT) (median 46 (IQR: 16–60) days post-LAAC) vs. 6 (40%) after DAPT discontinuation (median 124 (81–210) days post-LAAC), translating into annualized CSB rates of 14.0% (per patient-year on DAPT) vs. 4.6% (per patient-year without DAPT). In 92.9% (13/14) of patients, the post-LAAC nonprocedural CSB was a recurrence from the same site as bleeding pre-LAAC. In the multivariable model, admission systolic blood pressure (SBP) > 127 mmHg (HR = 10.73, 1.37–84.26, p = 0.024), epistaxis history (HR = 5.84, 1.32–25.89, p = 0.020), permanent atrial fibrillation (AF) (HR = 4.55, 1.20–17.20, p = 0.025), and prior gastrointestinal bleeding (HR = 3.35, 1.01–11.08, p = 0.048) predicted post-LAAC CSB. Conclusions: Nonprocedural CSBs after LAAC, with a similar origin as the pre-LAAC bleedings, were observed predominantly during postprocedural DAPT and predicted by elevated admission SBP, prior epistaxis, permanent AF, and gastrointestinal bleeding history. Whether a more reserved post-LAAC antiplatelet regimen and stringent blood pressure control may improve LAAC outcomes remains to be studied.
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spelling pubmed-96587982022-11-15 Incidence and Predictors of Clinically Significant Bleedings after Transcatheter Left Atrial Appendage Closure Zieliński, Kamil Pracoń, Radosław Konka, Marek Kruk, Mariusz Kępka, Cezary Trochimiuk, Piotr Dębski, Mariusz Kaczmarska, Edyta Przyłuski, Jakub Kowalik, Ilona Dzielińska, Zofia Kurowski, Andrzej Witkowski, Adam Demkow, Marcin Int J Environ Res Public Health Article Background: Transcatheter left atrial appendage closure (LAAC) is performed in patients unsuitable for long-term anticoagulation, predominantly due to prior bleeding events. The study aimed to investigate the incidence and predictors of clinically significant bleeding (CSB) post-LAAC. Methods: Consecutive patients after LAAC with an Amplatzer or WATCHMAN device were analyzed (05.2014–11.2019). Bleeding was classified as CSB when associated with at least one of the following: death, ≥2 g/dL hemoglobin drop, ≥2 blood units transfusion, critical anatomic site, or hospitalization/invasive procedure. Results: Among 195 patients (age 74 (68–80), 43.1% females, HAS-BLED score 2.0 (2.0–3.0)), during median follow-up of 370 (IQR, 358–392) days, there were 15 nonprocedural CSBs in 14 (7.2%) patients. Of those, 9 (60.0%) occurred during postprocedural dual antiplatelet therapy (DAPT) (median 46 (IQR: 16–60) days post-LAAC) vs. 6 (40%) after DAPT discontinuation (median 124 (81–210) days post-LAAC), translating into annualized CSB rates of 14.0% (per patient-year on DAPT) vs. 4.6% (per patient-year without DAPT). In 92.9% (13/14) of patients, the post-LAAC nonprocedural CSB was a recurrence from the same site as bleeding pre-LAAC. In the multivariable model, admission systolic blood pressure (SBP) > 127 mmHg (HR = 10.73, 1.37–84.26, p = 0.024), epistaxis history (HR = 5.84, 1.32–25.89, p = 0.020), permanent atrial fibrillation (AF) (HR = 4.55, 1.20–17.20, p = 0.025), and prior gastrointestinal bleeding (HR = 3.35, 1.01–11.08, p = 0.048) predicted post-LAAC CSB. Conclusions: Nonprocedural CSBs after LAAC, with a similar origin as the pre-LAAC bleedings, were observed predominantly during postprocedural DAPT and predicted by elevated admission SBP, prior epistaxis, permanent AF, and gastrointestinal bleeding history. Whether a more reserved post-LAAC antiplatelet regimen and stringent blood pressure control may improve LAAC outcomes remains to be studied. MDPI 2022-10-24 /pmc/articles/PMC9658798/ /pubmed/36360682 http://dx.doi.org/10.3390/ijerph192113802 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
Zieliński, Kamil
Pracoń, Radosław
Konka, Marek
Kruk, Mariusz
Kępka, Cezary
Trochimiuk, Piotr
Dębski, Mariusz
Kaczmarska, Edyta
Przyłuski, Jakub
Kowalik, Ilona
Dzielińska, Zofia
Kurowski, Andrzej
Witkowski, Adam
Demkow, Marcin
Incidence and Predictors of Clinically Significant Bleedings after Transcatheter Left Atrial Appendage Closure
title Incidence and Predictors of Clinically Significant Bleedings after Transcatheter Left Atrial Appendage Closure
title_full Incidence and Predictors of Clinically Significant Bleedings after Transcatheter Left Atrial Appendage Closure
title_fullStr Incidence and Predictors of Clinically Significant Bleedings after Transcatheter Left Atrial Appendage Closure
title_full_unstemmed Incidence and Predictors of Clinically Significant Bleedings after Transcatheter Left Atrial Appendage Closure
title_short Incidence and Predictors of Clinically Significant Bleedings after Transcatheter Left Atrial Appendage Closure
title_sort incidence and predictors of clinically significant bleedings after transcatheter left atrial appendage closure
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9658798/
https://www.ncbi.nlm.nih.gov/pubmed/36360682
http://dx.doi.org/10.3390/ijerph192113802
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