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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...
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/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. |
format | Online Article Text |
id | pubmed-9658798 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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