Your browser doesn't support javascript.
loading
Long-term safety and efficacy of left atrial appendage occlusion in dialysis patients with atrial fibrillation: a multi-center, prospective, open label, observational study.
Genovesi, Simonetta; Porcu, Luca; Rebora, Paola; Slaviero, Giorgio; Casu, Gavino; Bertoli, Silvio; Airoldi, Flavio; Buskermolen, Monique; Gallieni, Maurizio; Pieruzzi, Federico; Rovaris, Giovanni; Montoli, Alberto; Piccaluga, Emanuela; Molon, Giulio; Alberici, Federico; Adamo, Marianna; Gaspardone, Achille; D'Angelo, Giuseppe; Merella, Pierluigi; Vezzoli, Giuseppe; Trezzi, Barbara; Mazzone, Patrizio.
Afiliación
  • Genovesi S; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Porcu L; Istituto Auxologico Italiano, IRCCS, Milan, Italy.
  • Rebora P; Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK.
  • Slaviero G; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Casu G; Nephrology Unit, IRCCS Ospedale San Raffaele, Milano, Italy.
  • Bertoli S; Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy.
  • Airoldi F; Dialysis and Nephrology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy.
  • Buskermolen M; Electrophysiology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy.
  • Gallieni M; Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy.
  • Pieruzzi F; Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco, Milano, Italy.
  • Rovaris G; Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy.
  • Montoli A; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Piccaluga E; Istituto Auxologico Italiano, IRCCS, Milan, Italy.
  • Molon G; Interventional Electrophysiology Unit, San Gerardo Hospital, Monza, Italy.
  • Alberici F; Nephrology Unit, Niguarda Hospital, Milano, Italy.
  • Adamo M; Interventional Cardiology Unit, Niguarda Hospital, Milano, Italy.
  • Gaspardone A; Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy.
  • D'Angelo G; Nephrology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy.
  • Merella P; Cardiology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy.
  • Vezzoli G; Cardiology Unit, S.Eugenio Hospital, Roma, Italy.
  • Trezzi B; Cardiac Pacing Unit, IRCCS Ospedale San Raffaele, Milano, Italy.
  • Mazzone P; Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy.
Clin Kidney J ; 16(12): 2683-2692, 2023 Dec.
Article en En | MEDLINE | ID: mdl-38046009
Background: The prevalence of atrial fibrillation (AF) in end stage kidney disease (ESKD) patients undergoing dialysis is high, however, the high risk of bleeding often hampers with a correct anticoagulation in ESKD patients with AF, despite high thromboembolic risk. Left atrial appendage (LAA) occlusion is a anticoagulation (OAT) for thromboembolism prevention in AF populations with high hemorrhagic risk. Methods and Results: The purpose of the study was to evaluate the efficacy and safety of LAA occlusion in a cohort of dialysis patients undergoing the procedure (LAA occlusion cohort, n = 106), in comparison with two other ESKD cohorts, one taking warfarin (Warfarin cohort, n = 114) and the other without anticoagulation therapy (No-OAT cohort, n = 148). After a median follow-up of 4 years, a Cox regression model, adjusted for possible confounding factors, showed that the hazard ratios (HRs) of thromboembolic events in the LAA occlusion cohort were 0.19 (95%CI 0.04-0.96; p = 0.045) and 0.16 (95%CI 0.04-0.66; p = 0.011) as compared with Warfarin and No-OAT cohorts, respectively. The HR of bleeding in the LAA occlusion cohort was 0.37 (95%CI 0.16-0.83; p = 0.017) compared to Warfarin cohort, while there were no significant differences between the LAA occlusion and the No-OAT cohort (HR 0.51; 95%CI 0.23-1.12; p = 0.094). Adjusted Cox regression models showed lower mortality in patients undergoing LAA occlusion as compared with both the Warfarin cohort (HR 0.60; 95%CI 0.38-0.94; p = 0.027) and no-OAT cohort (HR 0.52; 95%CI 0.34-0.78; p = 0.002). Thromboembolic events in the LAA occlusion cohort were lower than expected according to the CHA2DS2VASc score (1.7 [95%CI 0.3-3.0] vs 6.7 events per 100 person/years, p < 0.001). Conclusion: In ESKD patients with AF, LAA occlusion is safe and effective and is associated with reduced mortality compared with OAT or no therapy.
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Clin Kidney J Año: 2023 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Clin Kidney J Año: 2023 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Reino Unido