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Impact of early bleeding on long-term mortality after left atrial appendage occlusion.
Lo Russo, Gerardo V; Balla, Abdalla Kara; Alarouri, Hasan S; Liu, Chia-Hao; Adi, Mahmoud Zhour; Killu, Ammar M; Alkhouli, Mohamad.
Afiliación
  • Lo Russo GV; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
  • Balla AK; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
  • Alarouri HS; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
  • Liu CH; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
  • Adi MZ; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
  • Killu AM; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
  • Alkhouli M; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: Alkhouli.Mohamad@mayo.edu.
Heart Rhythm ; 2024 Jul 18.
Article en En | MEDLINE | ID: mdl-39032523
ABSTRACT

BACKGROUND:

Short-term antithrombotic therapy is recommended after left atrial appendage occlusion (LAAO) to reduce the risk of device-related thrombosis. However, patients referred for LAAO have excess bleeding risk. Yet, short-term bleeding events post-LAAO are not well characterized.

OBJECTIVES:

We aimed to evaluate the incidence of early bleeding post-LAAO and its association with long-term mortality risk. We also sought to identify predictors of early bleeding.

METHODS:

Patients who underwent LAAO at Mayo Clinic between 2018 and 2023 were included. Early bleeding was defined as bleeding that occurred within 3 months of discharge. A multivariable Cox proportional hazards model was used to assess the association between early bleeding and death and to estimate the hazard ratio. Multivariable regression analysis was used to identify predictors of early bleeding.

RESULTS:

Of the 592 patients included, 389 (66%) were male, and the mean age was 75.6 years. Eighty-three patients (14.0%) experienced early bleeding, with the majority having minimal (63.4%) or minor (17.3%) bleeding. At a median follow-up of 14.4 months (interquartile range 4.2-27.9 months), early bleeding after LAAO was associated with an increased risk of all-cause mortality (adjusted hazard ratio 2.07; 95% confidence interval 1.15-3.75; P = .02). A history of intracranial bleeding, nonparoxysmal atrial fibrillation, CHA2DS2-VASc score, and early device-related thrombosis were independent predictors of early bleeding. Antithrombotic therapy at discharge was not associated with early nonprocedural bleeding.

CONCLUSION:

One in 7 patients experience a nonprocedural bleeding event within 90 days of LAAO. Early bleeding after LAAO is associated with a higher all-cause mortality risk during mid-term follow-up. Further studies are needed to optimize the management of patients undergoing LAAO.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Heart Rhythm Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos
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: Heart Rhythm Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos