Atrial Fibrillation
Read Time: 2 mins

113/Left atrial appendage occlusion for atrial fibrillation and bleeding diathesis

Published Online: October 9th 2012 European Journal of Arrhythmia & Electrophysiology. 2022;8(Suppl. 1):abstr113
Authors: BS Kailey (Presenting Author) – Imperial College London, London; M Koa-Wing – Imperial College Healthcare NHS Trust, London; N Sutaria – Imperial College Healthcare NHS Trust, London; T Mott – Abbott Healthcare, London; A Sohaib – Barts Healthcare NHS Trust, London; N Qureshi – Imperial College Healthcare NHS Trust, London; C Wadsworth – Imperial College Healthcare NHS Trust, London; S Jamil – Imperial College Healthcare NHS Trust, London; L D’Anna – Imperial College Healthcare NHS Trust, London; C Shi – Imperial College Healthcare NHS Trust, London; P Padam – Imperial College Healthcare NHS Trust, London; J Howard – Imperial College Healthcare NHS Trust, London; S Levy – Imperial College Healthcare NHS Trust, London; B Porter – Imperial College Healthcare NHS Trust, London; Z Whinnett – Imperial College Healthcare NHS Trust, London; N Linton – Imperial College Healthcare NHS Trust, London; B Lim – Imperial College Healthcare NHS Trust, London; N Peters – Imperial College Healthcare NHS Trust, London; FS Ng – Imperial College Healthcare NHS Trust, London; D Keene – Imperial College Healthcare NHS Trust, London; L Malcolme-Lawes – Imperial College Healthcare NHS Trust, London; D Lefroy – Imperial College Healthcare NHS Trust, London; G Cole – Imperial College Healthcare NHS Trust, London; P Asaria – Imperial College Healthcare NHS Trust, London; B Ariff – Imperial College Healthcare NHS Trust, London; D Gopalan – Imperial College Healthcare NHS Trust, London; A Varnava – Imperial College Healthcare NHS Trust, London; P Pabari – Imperial College Healthcare NHS Trust, London; B Rana – Imperial College Healthcare NHS Trust, London; P Kanagaratnam – Imperial College Healthcare NHS Trust, London
Quick Links:
Article
Article Information
Article:

Introduction: Patients with atrial fibrillation (AF) and likelihood of bleeding can undergo left atrial appendage occlusion (LAAO) as an alternative method of stroke prophylaxis. A short course of anti-thrombotic drugs is used post-procedure to offset the risk of device-related thrombus, but evidence for this practice is limited.

Methods: Patients with AF and high risk for both stroke and bleeding were advised about their management strategy by a multidisciplinary physician panel. This included the perioperative drug therapy for those patients advised to undergo LAAO. Those deemed to be at unduly high risk of bleeding from anti-thrombotic drugs were assigned to minimal treatment with no anti-thrombotic drugs or aspirin alone. The remaining patients received standard care with a 6–12-week course of dual antiplatelets or anticoagulation following device implant. We compared mortality, device-related thrombus, ischaemic stroke and bleeding events during the 90 days post-implant and long term. Event-free survival was assessed using Kaplan–Meier survival analysis, with log rank testing for statistical significance.

Results: A total of 75 patients underwent LAAO (Amulet™, Abbott Medical) of whom 63 (84%) had a prior serious bleeding event. The 42 patients on minimal treatment were older (74.3 ± 7.7 vs 71.2 ± 7.2) and had higher HASBLED score (3.6 ± 0.9 vs 3.3 ± 1.2) than the 33 patients receiving standard care. There were no device-related thrombi or strokes in either group in the 90 days post-procedure, but patients having standard treatment had more bleeding events (5/33 vs 0/42; p=0.01) with associated deaths (3/33 vs 0/42; p=0.05). During median long-term follow-up of 2.2 years, all patients were transitioned onto no antithrombotic drugs (43 patients [61%]) or a single antiplatelet (29 patients [39%]). There was no evidence of early minimal treatment adversely affecting long-term outcomes.

Conclusions: Short-term anti-thrombotic drugs are not needed after LAAO implant in patients with high bleeding risk and this is the first clinical study to show that they may be harmful. 

Further Resources

Share this Article
Related Content In Atrial Fibrillation
  • Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72