Percutaneous Left Atrial Appendage Occlusion: An Emerging Option in Patients with Atrial Fibrillation at High Risk of Bleeding

Cimmino, Giovanni; Loffredo, Francesco; Gallinoro, Emanuele; Prozzo, Dario; Fabiani, D.; Cante, Luigi Colucci; Salerno, Gemma; Bigazzi, Maurizio Cappelli; Golino, Paolo

doi:10.3390/medicina57050444

Cited by 12 publications

(7 citation statements)

References 74 publications

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“…For patients with severe bleeding caused by dabigatran, it is recommended to use idarucizumab immediately for reversal and monitor the vital signs continuously. Percutaneous Left Atrial Appendage Occlusion (LAAO) represents a safe alternative for those patients with contraindications for long-term oral anticoagulation and high bleeding risk or after experiencing life-threatening bleedings ( Cimmino et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Fatal Adverse Events of Dabigatran Combined With Aspirin in Elderly Patients: An Analysis Using Data From VigiBase

et al. 2021

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Introduction: The elderly are vulnerable to cardiovascular diseases and the incidence of atrial fibrillation (AF) and venous thromboembolism (VTE) increases significantly with age. Dabigatran is a commonly used new oral anticoagulant approved by the FDA for stroke prevention in patients with non-valvular AF and VTE treatment and prevention. Aspirin is commonly used as a preventive drug for cardiovascular diseases. AF and coronary heart disease share many risk factors, so these two diseases often coexist and thus dabigatran and aspirin are often combined in those people. The aim of this study was to analyze the clinical characteristics of fatal adverse events of dabigatran combined with aspirin in elderly patients, and to provide references for clinical rational use of drugs.Materials and Methods: Fatal adverse events related to the combined use of dabigatran and aspirin in elderly patients aged over 75 were extracted from the WHO global database of individual case safety reports (VigiBase). Well-documented reports, vigiGrade completeness score ≥0.80, or with an informative narrative, were analyzed with a focus on the clinical features of the cases.Results: From 1968 up to January 19, 2020, there were 112 eligible reports in VigiBase from 13 countries, of which 33 were identified as well-documented. Of these 33, 19 were male (58%) and 14 were female (42%), the average age of the patients was 84 (75–95 years), with five cases of extreme weights (>100 kg in one case, <50 kg in four cases). There were 31 cases of death by internal bleeding (mainly 15 of gastrointestinal hemorrhage and 12 of intracranial hemorrhage) and two cases of the sudden death of unknown cause. Medication errors existed in 15 patients. The times to onset (TTO) was provided in 24 cases, ranging from 2 days to 4 years, and in 12 patients occurred within a month. Of the 31 patients with fatal bleeding events, 29 were associated with other factors that increase the risk of bleeding, such as diseases (hypertension, renal impairment, stroke, gastrointestinal related diseases, hypothyroidism, and cancer), drugs (antiplatelets, anticoagulants, thrombolytics, P glycoprotein substrates, non-steroidal anti-inflammatory drugs, hormones, selective serotonin reuptake inhibitors, and acetaminophen) and other factors (low body weights and alcohol consumption), and 21 of these contained two or more risk factors.Conclusion: The fatal adverse events associated with the combined use of dabigatran and aspirin in elderly patients were mainly serious bleeding events, which often occurred within 1 month. Most of these cases had medication errors and most of the patients had multiple diseases, medications, or other conditions at the same time that increase the risk of bleeding. It is suggested that prescription of dabigatran and aspirin in elderly patients should go along with alertness for medication errors, care for correct dose or control of other bleeding risk factors, and the combined medication time should be as short as possible to minimise serious adverse events.

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Section: Discussionmentioning

confidence: 99%

Fatal Adverse Events of Dabigatran Combined With Aspirin in Elderly Patients: An Analysis Using Data From VigiBase

et al. 2021

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“…Anticoagulant therapy was recommended, but the patient refused to take long-term oral anticoagulants, so LAA occlusion was selected. Following the cryoballoon PVI, the patient underwent LAA occlusion under transesophageal echocardiographic (TEE) monitoring[ 9 ]. A special sheathing canal was placed to perform LAA angiography, and a pigtail angiographic catheter was directed to the LAA with the following positions: Right anterior oblique 30° + cranial 20° and right anterior oblique 30° + caudal 20°.…”

Section: Treatmentmentioning

confidence: 99%

Cryoballoon pulmonary vein isolation and left atrial appendage occlusion prior to atrial septal defect closure: A case report

Wu¹,

Wang²,

Chen³

et al. 2022

WJCC

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BACKGROUND In patients who suffer from both atrial fibrillation (AF) and atrial septal defect (ASD), cryoballoon pulmonary vein isolation (PVI), sequential left atrial appendage (LAA) occlusion and ASD closure could be a strategy for effective prevention of stroke and right heart failure. CASE SUMMARY A 65-year-old man was admitted to our institution due to recurrent episodes of palpitations and shortness of breath for 2 years, which had been worsening over the last 48 h. He had a history of AF, ASD, coronary heart disease with stent implantation and diabetes. Physical and laboratory examinations showed no abnormalities. The score of CHA2DS2VASc was 3, and HAS-BLED was 1. Echocardiography revealed a 25-mm secundum ASD. Pulmonary vein (PV) and LAA anatomy were assessed by cardiac computed tomography. PV mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete PVI. Following the cryoballoon PVI, the patient underwent LAA occlusion under transesophageal echocardiographic monitoring. Lastly, a 34-mm JIYI ASD occlude device was implanted. A follow-up transesophageal echocardiography at 3 mo showed proper position of both devices and neither thrombi nor leakage was found. CONCLUSION Sequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.

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“…Oral anticoagulation with non-vitamin K oral anticoagulants (NOACs) or vitamin K antagonists are recommended as the rst-line treatment for reducing stroke risk, but bleeding complications and nonadherence are barriers to effective anticoagulation therapy [2]. Considering more than 90% of the thrombus locating inside the left atrial appendage [3], percutaneous left atrial appendage closure(LAAC) emerged in recent years for stroke risk reduction in nonvalvular AF patients, particularly in those with contraindications, intolerance or refusal to oral anticoagulation therapy [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Clinical relevance of incomplete device endothelialization after left atrial appendage closure

Chen

Xing

et al. 2022

Int J Cardiovasc Imaging

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This study aimed to assess the incidence, potential risk factors and clinical impact of incomplete device endothelialization (IDE) after left atrial appendage closure (LAAC). MethodsA total of 101 consecutive patients with nonvalvular atrial brillation (AF) who underwent successful LAAC and received antithrombotic treatment using a standard regimen were prospectively followed up to 6 months after the procedure. The status of device endothelialization and device-related thrombus (DRT) were evaluated using cardiac computed tomography (CT). Major adverse cardio-cerebral events (MACCE) including all-cause death, heart failure(HF) hospitalization, acute ischemic stroke, transient ischemic attack(TIA), peripheral vascular embolism, and major bleeding were recorded. ResultsIDE was detected in 65 (64.4%) patients. Patients with IDE or complete device endothelialization (CDE) did not signi cantly differ with respect to baseline clinical characteristics and interventional procedure features. Multivariate analysis model revealed that persistent AF, left atrial appendage ostial diameter and left atrial size were independent risk factors for IDE. During 6-month follow-up, the incidence of DRT was 4.6% in patients with IDE and 2.8% in those with CDE, respectively (p > 0.05), and the overall rate of MACCE was non-signi cantly higher in the IDE group (7.7% vs. 2.8%, p = 0.32). ConclusionsIDE is common after LAAC, especially in patients with persistent AF, higher left atrial appendage ostial diameter and left atrial size. IDE confers an increased risk for DRT, but may be not necessarily associated with thromboembolic events and poor clinical outcome, providing careful monitoring and continued antithrombotic therapy are given.

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Percutaneous Left Atrial Appendage Occlusion: An Emerging Option in Patients with Atrial Fibrillation at High Risk of Bleeding

Cited by 12 publications

References 74 publications

Fatal Adverse Events of Dabigatran Combined With Aspirin in Elderly Patients: An Analysis Using Data From VigiBase

Fatal Adverse Events of Dabigatran Combined With Aspirin in Elderly Patients: An Analysis Using Data From VigiBase

Cryoballoon pulmonary vein isolation and left atrial appendage occlusion prior to atrial septal defect closure: A case report

Clinical relevance of incomplete device endothelialization after left atrial appendage closure

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