1. Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure.
- Author
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Marroquin L, Tirado-Conte G, Pracoń R, Streb W, Gutierrez H, Boccuzzi G, Arzamendi-Aizpurua D, Cruz-González I, Ruiz-Nodar JM, Kim JS, Freixa X, Lopez-Minguez JR, De Backer O, Ruiz-Salmeron R, Dominguez A, McInerney A, Peral V, Estevez-Loureiro R, Fernandez-Nofrerias E, Freitas-Ferraz AB, Saia F, Huczek Z, Gheorghe L, Salinas P, Demkow M, Delgado-Arana JR, Fernandez Peregrina E, Kalarus Z, Elvira Laffond A, Jang Y, Fernandez Camacho JC, Lee OH, Hernández-Garcia JM, Mas-Llado C, Caneiro Queija B, Amat-Santos IJ, Dabrowski M, Rodés-Cabau J, and Nombela Franco L
- Subjects
- Cardiac Catheterization adverse effects, Hemorrhage etiology, Humans, Time Factors, Treatment Outcome, Atrial Appendage diagnostic imaging, Atrial Fibrillation complications, Atrial Fibrillation therapy, Heart Diseases diagnostic imaging, Heart Diseases etiology, Heart Diseases therapy, Stroke complications, Stroke prevention & control, Thrombosis complications, Thrombosis prevention & control
- Abstract
Objective: Left atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus., Methods: This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively., Results: IAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102)., Conclusion: In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (~10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up., Competing Interests: Competing interests: Relationship with industry: LNF has served as a proctor for Abbott and has received speaker honoraria from Edwards Lifesciences and Boston Scientific. All other authors have reported that they have no relationships relevant to the content of this paper to disclose., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2022
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