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Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure.

Authors
  • Marroquin, Luis1
  • Tirado-Conte, Gabriela1
  • Pracoń, Radosław2
  • Streb, Witold3
  • Gutierrez, Hipolito4
  • Boccuzzi, Giacomo5
  • Arzamendi-Aizpurua, Dabit6
  • Cruz-González, Ignacio7
  • Ruiz-Nodar, Juan Miguel8
  • Kim, Jung-Sun9
  • Freixa, Xavier10
  • Lopez-Minguez, Jose Ramon11
  • De Backer, Ole12
  • Ruiz-Salmeron, Rafael13
  • Dominguez, Antonio14
  • McInerney, Angela1
  • Peral, Vicente15
  • Estevez-Loureiro, Rodrigo16
  • Fernandez-Nofrerias, Eduard17
  • Freitas-Ferraz, Afonso B18
  • And 19 more
  • 1 Interventional Cardiology. Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain. , (Spain)
  • 2 Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland. , (Poland)
  • 3 Silesian Centre for Heart Disease, Zabrze, Poland. , (Poland)
  • 4 Cardiology, Clinic University Hospital, Valladolid, Spain. , (Spain)
  • 5 Cardiology, Ospedale San Giovanni Bosco, Turin, Italy. , (Italy)
  • 6 Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. , (Spain)
  • 7 Cardiology, Hospital Universitario de Salamanca, IBSAL, CIBER CV, Salamanca, Spain. , (Spain)
  • 8 Cardiology, Hospital General Universitari d'Alacant, Alicante, Spain. , (Spain)
  • 9 Severance Cardiovascular Hospital, Yonsei, Korea (the Republic of). , (North Korea)
  • 10 Cardiology, Hospital Clinic of Barcelona, Barcelona, Spain. , (Spain)
  • 11 Cardiology, Hospital Universitario de Badajoz, Badajoz, Spain. , (Spain)
  • 12 Cardiology, Rigshospitalet, Kobenhavn, Denmark. , (Denmark)
  • 13 Cardiology, Hospital Universitario Virgen Macarena, Sevilla, Spain. , (Spain)
  • 14 Cardiology, Hospital Universitario Virgen de la Victoria, Malaga, Spain. , (Spain)
  • 15 Cardiology, Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain. , (Spain)
  • 16 Cardiology, University Hospital Complex Vigo, Vigo, Spain. , (Spain)
  • 17 Interventional Cardiology, HU Germans Trias i Pujol, Badalona, Spain. , (Spain)
  • 18 Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec, Ontario, Canada. , (Canada)
  • 19 Cardiology, University Hospital of Bologna, Bologna, Italy. , (Italy)
  • 20 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. , (Poland)
  • 21 Cardiology, Hospital Universitario Puerta del Mar, Cadiz, Spain. , (Spain)
  • 22 Interventional Cardiology and Angiology Clinic, National Institute of Cardiology, Warsaw, Poland. , (Poland)
  • 23 Interventional Cardiology. Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain [email protected] , (Spain)
Type
Published Article
Journal
Heart
Publisher
BMJ
Publication Date
Jun 24, 2022
Volume
108
Issue
14
Pages
1098–1106
Identifiers
DOI: 10.1136/heartjnl-2021-319811
PMID: 34686564
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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). 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 (~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. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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