Major Bleeding Predictors in Patients with Left Atrial Appendage Closure : The Iberian Registry II
| Autor: | López-Mínguez, José Ramón, Nogales-Asensio, Juan Manuel, Infante De Oliveira, Eduardo, Santos, Lino, Ruiz-Salmerón, Rafael, Arzamendi, Dabit, Costa, Marco, Gutiérrez-García, Hipólito, Fernández-Díaz, Jose Antonio, Freixa, Xavier, Cruz-González, Ignacio, Moreno, Raúl, Íñiguez-Romo, Andrés, Alfonso, Fernando, Universitat Autònoma de Barcelona |
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| Přispěvatelé: | UAM. Departamento de Medicina, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP) |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Gastrointestinal bleeding
medicine.medical_specialty Medicina Population lcsh:Medicine 030204 cardiovascular system & hematology left atrial appendage closure Article 03 medical and health sciences bleeding risk 0302 clinical medicine Age Internal medicine Bleeding risk Medicine atrial fibrillation 030212 general & internal medicine education Stroke education.field_of_study business.industry Vascular disease Proportional hazards model lcsh:R Atrial fibrillation Left atrial appendage closure General Medicine medicine.disease age Heart failure Liver function business |
| Zdroj: | Journal of Clinical Medicine r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname Biblos-e Archivo. Repositorio Institucional de la UAM Consejo Superior de Investigaciones Científicas (CSIC) Biblos-e Archivo: Repositorio Institucional de la UAM Universidad Autónoma de Madrid Volume 9 Issue 7 Journal of Clinical Medicine, Vol 9, Iss 2295, p 2295 (2020) Dipòsit Digital de Documents de la UAB Universitat Autònoma de Barcelona |
| ISSN: | 2077-0383 |
| Popis: | Introduction and objective: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in different series. This study aimed to clarify the bleeding predictive factors that could influence these differences. Methods: LAAC was performed in 598 patients from the Iberian Registry II (1093 patient-years median, 75.4 years). We conducted a multivariate analysis to identify predictive risk factors for major bleeding events. The occurrence of thromboembolic and bleeding events was compared to rates expected from CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drugs or alcohol) scores. Results: Cox regression analysis revealed that age &ge 75 years (HR: 2.5 95% CI: 1.3 to 4.8 p = 0.004) and a history of gastrointestinal bleeding (GIB) (HR: 2.1 95% CI: 1.1 to 3.9 p = 0.020) were two factors independently associated with major bleeding during follow-up. Patients aged < 75 or &ge 75 years had median CHA2DS2-VASc scores of 4 (IQR: 2) and 5 (IQR: 2), respectively (p < 0.001) and HAS-BLED scores were 3 (IQR: 1) and 3 (IQR: 1) for each group (p = 0.007). Events presented as follow-up adjusted rates according to age groups were stroke (1.2% vs. 2.9% HR: 2.4, p = 0.12) and major bleeding (3.7 vs. 9.0 per 100 patient-years HR: 2.4, p = 0.002). Expected major bleedings according to HAS-BLED scores were 6.2% vs. 6.6%, respectively. In patients with GIB history, major bleeding events were 6.1% patient-years (HAS-BLED score was 3.8 ± 1.1) compared to 2.7% patients-year in patients with no previous GIB history (HAS-BLED score was 3.4 ± 1.2 p = 0.029). Conclusions: In this high-risk population, GIB history and age &ge 75 years are the main predictors of major bleeding events after LAAC, especially during the first year. Age seems to have a greater influence on major bleeding events than on thromboembolic risk in these patients. |
| Databáze: | OpenAIRE |
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