Left atrial appendage closure device implantation in patients with prior intracranial hemorrhage
| Autor: | Amr F. Barakat, Ayman A. Hussein, Shazam Hussain, Walid Saliba, Oussama M. Wazni, Dolora Wisco, Bruce D. Lindsay, Mohamed Kanj, Andrew Russman, Samir R. Kapadia, Khaldoun G. Tarakji, Jose Aguilera, Peter A. Rasmussen, Ken Uchino, Erika Hutt |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Septal Occluder Device 030204 cardiovascular system & hematology Dabigatran Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine Hematoma Physiology (medical) Atrial Fibrillation medicine Humans Atrial Appendage cardiovascular diseases 030212 general & internal medicine Perioperative Period Stroke Aged business.industry Warfarin Anticoagulants Atrial fibrillation Perioperative medicine.disease Surgery Clinical trial Outcome and Process Assessment Health Care Female Risk Adjustment Apixaban Cardiology and Cardiovascular Medicine business Intracranial Hemorrhages Echocardiography Transesophageal medicine.drug |
| Zdroj: | Heart Rhythm. 16:663-668 |
| ISSN: | 1547-5271 |
| DOI: | 10.1016/j.hrthm.2018.11.022 |
| Popis: | Background The Watchman device (Boston Scientific), used for left atrial appendage closure (LAAC), was approved for stroke prevention in patients with atrial fibrillation (AF) and an appropriate rationale to avoid long-term oral anticoagulation. Patients with AF and prior intracranial hemorrhage (ICH) were excluded from clinical trials because of perceived risks of perioperative anticoagulation. Objective The purpose of this study was to study the efficacy and safety of LAAC using Watchman in patients with AF and prior ICH. Methods In a multidisciplinary AF/stroke prevention clinic, 38 consecutive patients with AF and prior ICH underwent Watchman implantation. Patients were enrolled in a prospectively maintained data registry. Results Patients' mean CHA2DS2-VASc score was 5.0 ± 1.3 and HAS-BLED score 4.2 ± 1.0. Prior ICH events were intraparenchymal (60%), subdural (24%), or subarachnoid bleeds (16%). The median event-to-implantation time was 637 days (minimum 60). Watchman was implanted in all patients with no procedural complications. All patients completed 45 days of anticoagulation with warfarin (55%), apixaban (37%), or dabigatran (8%). Transesophageal echocardiograms at 45 days showed no peridevice leak, and 1 patient had a small filamentous echodensity on device that resolved with anticoagulation. While undergoing anticoagulation, none of the patients developed recurrent ICH. Minor bleeding occurred in 1 patient (trauma-related lower extremity hematoma at 19 days postimplantation). At 13.4 months (quartiles 8–19) of follow-up, there were no strokes, ICH, or deaths. Conclusion AF patients with prior ICH tolerated short-term anticoagulation for the purpose of Watchman implantation. LAAC with attendant short-term anticoagulation seems to be both safe and effective in this patient population. |
| Databáze: | OpenAIRE |
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