Outcomes of Left Atrial Appendage Closure in Hemodialysis Patients With Atrial Fibrillation

Figures

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  Figure 1. Transition of Antithrombotic Drug Regimen Before and After LAAC (A) Overall cohort, (B) nonhemodialysis (HD) group, (C) HD group. At baseline, 11% of cases in the HD group were not on anticoagulant therapy, but instead, the percentage of cases on antiplatelet therapy was higher compared with the non-HD group. At short-term and 1 year, 95% of cases in the HD group had successfully discontinued anticoagulant therapy. DAPT = dual antiplatelet therapy; LAAC = left atrial appendage closure; OAC = oral anticoagulant; SAPT = single antiplatelet therapy.

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  Figure 2. Kaplan-Meier Curve for Adverse Events Following LAAC (A) All-cause death, (B) cardiovascular death, (C) major bleeding, and (D) ischemic stroke. All-cause mortality and cardiovascular mortality were higher in the HD group compared with the non-HD group. Nevertheless, major bleeding and ischemic stroke were comparable between groups, and device-related thrombosis (DRT) tended to be lower in the HD group. Abbreviations as in Figure 1.

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  Central Illustration. Outcomes of HD Patients Undergoing LAAC From the OCEAN-LAAC Registry Left atrial appendage closure (LAAC) for the hemodialysis (HD) patients demonstrated comparable outcomes to non-HD patients in terms of procedural success and complications. The incidence of adverse events including major bleeding and ischemic stroke was equivalent between the 2 groups. In an indirect comparison between previously reported HD cohort, the HD cohort from the OCEAN (Optimized CathEter vAlvular iNtervention)-LAAC registry had lower incidence of ischemic stroke. NVAF = nonvalvular atrial fibrillation.

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  Figure 3. Ischemic Stroke Rates After LAAC Compared to Previous Studies The event rate of ischemic stroke in the HD cohort was higher compared to the non-HD cohort. Left atrial appendage closure (LAAC) in the HD cohort could reduce the event rate of ischemic stroke comparable to the reduction observed in HD patients receiving anticoagulant therapy.22,23 Abbreviations as in Figure 1.