Percutaneous left atrial appendage closure in patients with gastrointestinal bleeding associated with oral anticoagulants.
| Autor: | Sanz Segura P; Gastroenterology Department, Royo Villanova Hospital, Zaragoza, Spain., Jimeno Sánchez J; Interventional Cardiology Unit, Miguel Servet University Hospital, Zaragoza, Spain., Arbonés-Mainar JM; Translational Research Unit, Instituto Aragonés de Ciencias de la Salud (IACS), Miguel Servet University Hospital, Zaragoza, Spain.; Instituto de Investigación Sanitaria (IIS) Aragon, Zaragoza, Spain.; Centro de Investigación Biomédica en Red Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain., Sánchez-Rubio Lezcano J; Interventional Cardiology Unit, Miguel Servet University Hospital, Zaragoza, Spain., Galache Osuna G; Interventional Cardiology Unit, Miguel Servet University Hospital, Zaragoza, Spain., Bernal Monterde V; Instituto de Investigación Sanitaria (IIS) Aragon, Zaragoza, Spain.; Gastroenterology Department, Miguel Servet University Hospital, Zaragoza, Spain. |
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| Jazyk: | angličtina |
| Zdroj: | Scandinavian journal of gastroenterology [Scand J Gastroenterol] 2023 Jul-Dec; Vol. 58 (12), pp. 1547-1554. Date of Electronic Publication: 2023 Jul 25. |
| DOI: | 10.1080/00365521.2023.2239973 |
| Abstrakt: | Introduction: Percutaneous left atrial appendage closure (LAAC) has shown non-inferiority compared to oral anticoagulation (OAC) in preventing atrial fibrillation (AF)-related stroke. The objective of this study was to assess whether LAAC reduces the incidence of gastrointestinal bleeding (GIB) and/or chronic anaemia associated with OAC, as well as the consumption of healthcare resources. Materials and Methods: Prospective, single-center study from 2016 to 2022, LAAC was performed. Clinical, analytical and healthcare resource consumption data were collected (endoscopies, blood transfusions, hospital admissions) prior and 6 months after LAAC. Results: 43 patients were included, with an average age of 77.6 years. LAAC indication was upper, low and obscure GIB in 7 (16%), 8 (19%) and 28 patients (65%) respectively. GIB source was intestinal angiodysplasias in 27 patients (63%), occult origin in 12 (28%), and others (antral vascular ectasia, portal hypertension gastropathy, etc.) in 4 patients (9%). The mean number of packed red blood cells per patient before LAAC was (mean ± SD) 7.29 ± 5 vs 0.42 ± 1.3 ( p < 0.001); endoscopic procedures were 4.34 ± 2.85 vs 0.27 ± 0.76 ( p < 0.001); and hospitalizations 2.67 ± 2.14 vs 0.03 ± 0.17 ( p < 0.001), with a hospital stay of 21.5 ± 17.3 vs 0.09 ± 0.5 days ( p < 0.001) at 6 months post-intervention. Haemoglobin value increased from 8.1 ± 1.2g/dl to 12.4 ± 2.2g/dl ( p < 0.001) at 6 months. No thromboembolic events were registered during a median follow-up of 16.6 months (range 6-65). Conclusions: LAAC could be a safe and effective alternative to OAC in patients with non-valvular AF presenting significant, recurrent or potentially unresolvable GIB. This intervention also leads to important savings in the consumption of healthcare resources. |
| Databáze: | MEDLINE |
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