Affordable Access

deepdyve-link
Publisher Website

Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis.

Authors
  • Genovesi, Simonetta1, 2
  • Porcu, Luca3
  • Slaviero, Giorgio4
  • Casu, Gavino5
  • Bertoli, Silvio6
  • Sagone, Antonio7
  • Buskermolen, Monique8
  • Pieruzzi, Federico9, 10
  • Rovaris, Giovanni11
  • Montoli, Alberto12
  • Oreglia, Jacopo13
  • Piccaluga, Emanuela13
  • Molon, Giulio14
  • Gaggiotti, Mario15
  • Ettori, Federica16
  • Gaspardone, Achille17
  • Palumbo, Roberto18
  • Viazzi, Francesca19
  • Breschi, Marco20
  • Gallieni, Maurizio8
  • And 7 more
  • 1 Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy. [email protected] , (Italy)
  • 2 Nephrology Unit, San Gerardo Hospital, Monza, Italy. [email protected] , (Italy)
  • 3 Laboratory of Methodology for Clinical Research, Oncology Department, Istituto di Ricerche Farmacologiche IRCCS Mario Negri, Milan, Italy. , (Italy)
  • 4 Nephrology Unit, IRCCS Ospedale San Raffaele, Milan, Italy. , (Italy)
  • 5 San Francesco Hospital, Nuoro. ATS Sardegna Nuoro, Nuoro, Italy. , (France)
  • 6 Dialysis and Nephrology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy. , (Italy)
  • 7 Electrophysiology Unit-IRCCS-Multimedica, Sesto S.Giovanni, Italy. , (Italy)
  • 8 Department of Nephrology and Dialysis, Luigi Sacco Hospital, Milan, Italy. , (Italy)
  • 9 Dipartimento di Medicina e Chirurgia-School of Medicine and Surgery, Università di Milano-Bicocca-University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy. , (Italy)
  • 10 Nephrology Unit, San Gerardo Hospital, Monza, Italy. , (Italy)
  • 11 Interventional Electrophysiology Unit, San Gerardo Hospital, Monza, Italy. , (Italy)
  • 12 Nephrology Unit, Niguarda Hospital, Milan, Italy. , (Italy)
  • 13 Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy. , (Italy)
  • 14 Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy. , (Italy)
  • 15 Nephrology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy. , (Italy)
  • 16 Cardiology Unit, ASST degli Spedali Civili di Brescia, Brescia, Italy. , (Italy)
  • 17 Cardiology Unit, S.Eugenio Hospital, Rome, Italy. , (Italy)
  • 18 Nephrology Unit, S.Eugenio Hospital, Rome, Italy. , (Italy)
  • 19 Nephrology Unit, San Martino-IST, Genoa, Italy. , (Italy)
  • 20 Cardiology Unit, USL Toscana Sud-Est, Grosseto, Italy. , (Italy)
  • 21 Cardiac Pacing Unit, IRCCS Ospedale San Raffaele, Milan, Italy. , (Italy)
Type
Published Article
Journal
Journal of nephrology
Publication Date
Feb 01, 2021
Volume
34
Issue
1
Pages
63–73
Identifiers
DOI: 10.1007/s40620-020-00774-5
PMID: 32535831
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In patients with end stage renal disease and atrial fibrillation (AF), undergoing chronic dialysis, direct oral agents are contraindicated and warfarin does not fully prevent embolic events while increasing the bleeding risk. The high hemorrhagic risk represents the main problem in this population. Aim of the study was to estimate the safety and efficacy for thromboembolic prevention of left atrial appendage (LAA) occlusion in a cohort of dialysis patients with AF and high hemorrhagic risk. Ninety-two dialysis patients with AF who underwent LAA occlusion were recruited. For comparative purposes, two cohorts of dialysis patients with AF, one taking warfarin (oral anticoagulant therapy, OAT cohort, n = 114) and the other not taking any OAT (no-therapy cohort, n = 148) were included in the study. Primary endpoints were (1) incidence of peri-procedural complications, (2) incidence of 2-year thromboembolic and hemorrhagic events, (3) mortality at 2 years. In order to evaluate the effect of the LAA occlusion on the endpoints with respect to the OAT and No-therapy cohorts, a multivariable Cox regression model was applied adjusted for possible confounding factors. The device was successfully implanted in 100% of cases. Two major peri-procedural complications were reported. No thromboembolic events occurred at 2-year follow-up. The adjusted multivariable Cox regression model showed no difference in bleeding risk in the OAT compared to the LAA occlusion cohort in the first 3 months of follow-up [HR 1.65 (95% CI 0.43-6.33)], when most of patients were taking two antiplatelet drugs. In the following 21 months the bleeding incidence became higher in OAT patients [HR 6.48 (95% CI 1.32-31.72)]. Overall mortality was greater in both the OAT [HR 2.76 (95% CI 1.31-5.86)] and No-Therapy [HR 3.09 (95% CI 1.59-5.98)] cohorts compared to LAA occlusion patients. The study could open the way to a non-pharmacological option for thromboembolic protection in dialysis patients with AF and high bleeding risk.

Report this publication

Statistics

Seen <100 times