Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure
Por:
Marroquin L., Tirado-Conte G., Pracon R., Streb W., Gutierrez H., Boccuzzi G., Arzamendi-Aizpurua D., Cruz-González I., Ruiz-Nodar J.M., Kim, JS, Freixa X., Lopez-Minguez J.R., De Backer O., Ruiz-Salmeron R., Dominguez A., McInerney A., Peral V., Estevez-Loureiro R., Fernandez-Nofrerias E., Freitas-Ferraz A.B., Saia F., Huczek Z., Gheorghe L., Salinas P., Demkow M., Delgado-Arana J.R., Peregrina, EF, Kalarus Z., Laffond, AE, Jang Y., Camacho, JCF, Lee, OH, Hernández-Garcia J.M., Mas-Llado C., Queija, BC, Amat-Santos I.J., Dabrowski M., Rodés-Cabau J., Franco, LN
Publicada:
1 jul 2022
Ahead of Print:
1 oct 2021
Resumen:
Objective Left atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus.
Methods This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively.
Results IAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102).
Conclusion In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (similar to 10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up.
Filiaciones:
Marroquin L.:
Hosp Clin San Carlos, Intervent Cardiol Cardiovasc Inst, IdISSC, Madrid, Spain
Tirado-Conte G.:
Hosp Clin San Carlos, Intervent Cardiol Cardiovasc Inst, IdISSC, Madrid, Spain
Pracon R.:
Natl Inst Cardiol, Dept Coronary & Struct Heart Dis, Warsaw, Poland
Streb W.:
Silesian Ctr Heart Dis, Zabrze, Poland
Gutierrez H.:
Clin Univ Hosp, Cardiol, Valladolid, Spain
Boccuzzi G.:
Osped San Giovanni Bosco, Cardiol, Turin, Italy
Arzamendi-Aizpurua D.:
Hosp Santa Creu & Sant Pau, Cardiol, Barcelona, Spain
Cruz-González I.:
Hosp Univ Salamanca, CIBER CV, IBSAL, Cardiol, Salamanca, Spain
Ruiz-Nodar J.M.:
Hosp Gen Univ Alacant, Cardiol, Alicante, Spain
Kim, JS:
Severance Cardiovasc Hosp, Yonsei, South Korea
Freixa X.:
Hosp Clin Barcelona, Cardiol, Barcelona, Spain
Lopez-Minguez J.R.:
Hosp Univ Badajoz, Cardiol, Badajoz, Spain
De Backer O.:
Rigshosp, Cardiol, Copenhagen, Denmark
Ruiz-Salmeron R.:
Hosp Univ Virgen Macarena, Cardiol, Seville, Spain
Dominguez A.:
Hosp Univ Virgen Victoria, Cardiol, Malaga, Spain
McInerney A.:
Hosp Clin San Carlos, Intervent Cardiol Cardiovasc Inst, IdISSC, Madrid, Spain
Peral V.:
Hosp Univ Son Espases, Hlth Res Inst Balearic Isl IdISBa, Cardiol, Palma De Mallorca, Spain
Estevez-Loureiro R.:
Univ Hosp Complex Vigo, Cardiol, Vigo, Spain
Fernandez-Nofrerias E.:
HU Germans Trias I Pujol, Intervent Cardiol, Badalona, Spain
Freitas-Ferraz A.B.:
Laval Univ, Quebec Heart & Lung Inst, Cardiol, Quebec City, PQ, Canada
Saia F.:
Univ Hosp Bologna, Cardiol, Bologna, Italy
Huczek Z.:
Med Univ Warsaw, Dept Cardiol 1, Warsaw, Poland
Gheorghe L.:
Hosp Univ Puerta Mar, Cardiol, Cadiz, Spain
Salinas P.:
Hosp Clin San Carlos, Intervent Cardiol Cardiovasc Inst, IdISSC, Madrid, Spain
Demkow M.:
Natl Inst Cardiol, Dept Coronary & Struct Heart Dis, Warsaw, Poland
Delgado-Arana J.R.:
Clin Univ Hosp, Cardiol, Valladolid, Spain
Peregrina, EF:
Hosp Santa Creu & Sant Pau, Cardiol, Barcelona, Spain
Kalarus Z.:
Silesian Ctr Heart Dis, Zabrze, Poland
Laffond, AE:
Hosp Univ Salamanca, CIBER CV, IBSAL, Cardiol, Salamanca, Spain
Jang Y.:
Severance Cardiovasc Hosp, Yonsei, South Korea
Camacho, JCF:
Hosp Univ Badajoz, Cardiol, Badajoz, Spain
Lee, OH:
Severance Cardiovasc Hosp, Yonsei, South Korea
Hernández-Garcia J.M.:
Hosp Univ Virgen Victoria, Cardiol, Malaga, Spain
Mas-Llado C.:
Hosp Univ Son Espases, Hlth Res Inst Balearic Isl IdISBa, Cardiol, Palma De Mallorca, Spain
Queija, BC:
Univ Hosp Complex Vigo, Cardiol, Vigo, Spain
Amat-Santos I.J.:
Clin Univ Hosp, Cardiol, Valladolid, Spain
Dabrowski M.:
Natl Inst Cardiol, Intervent Cardiol & Angiol Clin, Warsaw, Poland
Rodés-Cabau J.:
Laval Univ, Quebec Heart & Lung Inst, Cardiol, Quebec City, PQ, Canada
Franco, LN:
Hosp Clin San Carlos, Intervent Cardiol Cardiovasc Inst, IdISSC, Madrid, Spain
All Open Access, Hybrid Gold
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