Why the study?
Does left atrial appendage occlusion prevent thrombotic events without causing bleeding in a patient with atrial fibrillation and hereditary hemorrhagic telangiectasia who is intolerant to oral anticoagulation?
Does left atrial appendage occlusion prevent thrombotic events without causing bleeding in a patient with atrial fibrillation and hereditary hemorrhagic telangiectasia who is intolerant to oral anticoagulation?
Left atrial appendage occlusion may serve as a safe and effective alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation and hereditary hemorrhagic telangiectasia.
Hereditary hemorrhagic telangiectasia (HHT) is a predominantly inherited disorder of blood vessel structure, characterized by mucocutaneous telangiectasias, multiple arteriovenous malformations, and frequent epistaxis. A 67-year-old female with atrial fibrillation and high thromboembolic risk (CHADs2Vasc2: 4) with renal arterial thrombosis started oral anticoagulation (OAC). The patient had multiple episodes of heavy nasal and gastrointestinal bleeding (requiring multiple blood transfusions) such that OAC had to be interrupted, and a complementary investigation led to the diagnosis of HHT. Due to concomitant high thromboembolic and hemorrhagic risks, the patient was proposed left atrial appendage occlusion as an alternative to OAC intolerance. After the procedure, there were no new episodes of bleeding or thrombotic events.
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Frade et al. (2021) studied this question.
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