Liver cirrhosis is independently associated with increased in-hospital mortality in patients undergoing left atrial appendage occlusion device implantation

Thotamgari, Sahith Reddy; Sheth, Aakash; Patel, Harsh; Bretzman, John; Ward, Robert C.; Thakkar, Samarthkumar; Patel, Jaimin T.; Asirvatham, Samuel J.; Holmes, David R.; Egbe, Alexander C.; Deshmukh, Abhishek; DeSimone, Christopher V.

doi:10.1016/j.hrthm.2022.04.009

Cited by 5 publications

(6 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, literature suggests liver cirrhosis [ 28 ], female sex [ 29 ], and increased age combined with previous gastrointestinal bleeding [ 30 ] are predictive factors for procedural complications. These parameters were not associated with a worse prognosis in this analysis.…”

Section: Discussionmentioning

confidence: 99%

Not to Rush—Laboratory Parameters and Procedural Complications in Patients Undergoing Left Atrial Appendage Closure

Zweiker

Fiedler

Tóth

et al. 2022

JCM

View full text Add to dashboard Cite

Background: As a preventive procedure, minimizing periprocedural risk is crucially important during left atrial appendage closure (LAAC). Methods: We included consecutive patients receiving LAAC at nine centres and assessed the relationship between baseline characteristics and the acute procedural outcome. Major procedural complications were defined as all complications requiring immediate invasive intervention or causing irreversible damage. Logistic regression was performed and included age and left-ventricular function. Furthermore, the association between acute complications and long-term outcomes was evaluated. Results: A total of 405 consecutive patients with a median age of 75 years (37% female) were included. 47% had a history of stroke. Median CHA2DS2-VASc score was 4 (interquartile range, 3–5) and the median HAS-BLED score was 3 (2–4). Major procedural complications occurred in 7% of cases. Low haemoglobin (OR 0.8, 95% CI 0.65–0.99 per g/dL, p = 0.040) and end-stage kidney disease (OR 13.0, CI 2.5–68.5, p = 0.002) remained significant in multivariate analysis. Anaemia (haemoglobin < 12 and < 13 g/dL in female and male patients) increased the risk of complications 2.2-fold. Conclusions: The major complication rate was low in this high-risk patient population undergoing LAAC. End-stage kidney disease and low baseline haemoglobin were independently associated with a higher major complication rate.

show abstract

Section: Discussionmentioning

confidence: 99%

Not to Rush—Laboratory Parameters and Procedural Complications in Patients Undergoing Left Atrial Appendage Closure

Zweiker

Fiedler

Tóth

et al. 2022

JCM

View full text Add to dashboard Cite

show abstract

“…Recent retrospective data showed that 1.9% of left atrial appendage occlusion procedures between 2016 and 2019 in the US were performed in patients with cirrhosis. 87 Cirrhosis was associated with an increased in-hospital mortality (OR 8.6, 95% CI: 4.1-17.9), as well as an increased risk of intracerebral haemorrhage (OR 4.3, 95% CI: 1.7-10.7)…”

Section: Left Atrial Appendage Occlusionmentioning

confidence: 99%

“…As the left atrial appendage is the dominant source of intracardiac thrombi that increase the risk of stroke, patients with cirrhosis have been referred for left atrial appendage occlusion. Recent retrospective data showed that 1.9% of left atrial appendage occlusion procedures between 2016 and 2019 in the US were performed in patients with cirrhosis 87 . Cirrhosis was associated with an increased in‐hospital mortality (OR 8.6, 95% CI: 4.1–17.9), as well as an increased risk of intracerebral haemorrhage (OR 4.3, 95% CI: 1.7–10.7) and transient ischemic attacks (OR 6.9, 95% CI: 2.6–18.1) 87 .…”

Section: Atrial Fibrillation Management In Cirrhosismentioning

confidence: 99%

“…Recent retrospective data showed that 1.9% of left atrial appendage occlusion procedures between 2016 and 2019 in the US were performed in patients with cirrhosis 87 . Cirrhosis was associated with an increased in‐hospital mortality (OR 8.6, 95% CI: 4.1–17.9), as well as an increased risk of intracerebral haemorrhage (OR 4.3, 95% CI: 1.7–10.7) and transient ischemic attacks (OR 6.9, 95% CI: 2.6–18.1) 87 . These increased risks are most likely related to the need for heparin use during the procedure, as well as the temporary, but mandatory use of antithrombotic or anticoagulation immediately after the procedure to prevent device‐related thrombosis.…”

Section: Atrial Fibrillation Management In Cirrhosismentioning

confidence: 99%

“…and transient ischemic attacks (OR 6.9, 95% CI: 2.6-18.1). 87 These increased risks are most likely related to the need for heparin use during the procedure, as well as the temporary, but mandatory use of antithrombotic or anticoagulation immediately after the procedure to prevent device-related thrombosis. These findings should be considered when referring or evaluating patients with cirrhosis for left atrial appendage occlusion.…”

Section: Left Atrial Appendage Occlusionmentioning

confidence: 99%

See 2 more Smart Citations

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Vandenberk

Altieri

Liu

et al. 2022

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Summary Background Atrial fibrillation (AF) is the most common arrhythmia and its management in cirrhosis can be challenging due to the altered hepatic metabolism of medications and increased risk of bleeding. Aims To provide a comprehensive overview of the diagnosis, pathophysiology and management of AF in patients with cirrhosis from both a cardiology and a hepatology perspective. Methods An extensive literature search was performed using the terms ‘atrial fibrillation’ and ‘cirrhosis’. Guideline documents and consensus statements were explored. Results The prevalence of AF in patients with cirrhosis ranges between 6.6% and 14.2%, while the incidence of new‐onset AF in the post‐operative period after liver transplant ranged between 6.8% and 10.2%. AF in patients with cirrhosis is associated with adverse outcomes in both pre‐transplant and post‐transplant settings, including an increased risk of stroke when compared to the general population. We review the pathogenesis of AF in general and in cirrhosis. This review also provides guidance on the management of AF, including the use of anticoagulation and rate versus rhythm control. In the absence of strict contraindications, all patients with cirrhosis and AF should be anticoagulated. The use of DOACs is preferred over vitamin K antagonists. In patients with a high bleeding risk, a DOAC with an approved antidote may be preferred. Conclusions Atrial fibrillation is increased in patients with cirrhosis. AF management requires careful consideration of treatment options. Since patients with cirrhosis were excluded from all major randomised clinical trials, dedicated research on the pathophysiology and management of AF in cirrhosis is needed.

show abstract

Anticoagulation for stroke prevention in atrial fibrillation and treatment of venous thromboembolism and portal vein thrombosis in cirrhosis: guidance from the SSC of the ISTH

Carlin,

Cuker,

Gatt

et al. 2024

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Liver cirrhosis is independently associated with increased in-hospital mortality in patients undergoing left atrial appendage occlusion device implantation

Cited by 5 publications

References 5 publications

Not to Rush—Laboratory Parameters and Procedural Complications in Patients Undergoing Left Atrial Appendage Closure

Not to Rush—Laboratory Parameters and Procedural Complications in Patients Undergoing Left Atrial Appendage Closure

Review article: diagnosis, pathophysiology and management of atrial fibrillation in cirrhosis and portal hypertension

Anticoagulation for stroke prevention in atrial fibrillation and treatment of venous thromboembolism and portal vein thrombosis in cirrhosis: guidance from the SSC of the ISTH

Contact Info

Product

Resources

About