Why the study?
Impaired renal function increases bleeding risk and leads to frequent oral anticoagulation discontinuation in AF patients with CKD, making interventional LAAC a potential alternative strategy.
Does interventional left atrial appendage closure using the WATCHMAN device prevent cerebrovascular events and bleeding in patients with non-valvular atrial fibrillation and chronic kidney disease?
Does interventional left atrial appendage closure using the WATCHMAN device prevent cerebrovascular events and bleeding in patients with non-valvular atrial fibrillation and chronic kidney disease?
Left atrial appendage closure with the WATCHMAN device in NVAF patients with chronic kidney disease is associated with lower-than-expected rates of stroke and bleeding, though device-related thrombi are more frequent in women and those with severe CKD.
Supports LAA closure feasibility in CKD patients; leaves open higher device thrombus risk in women for prospective validation.
Impaired renal function increases the bleeding risk, leading to a conservative prescription and frequent discontinuation of oral anticoagulation in atrial fibrillation patients with chronic kidney disease (CKD). Interventional left atrial appendage closure (LAAC) might be an alternative therapeutic strategy for these patients. We aimed to prospectively assess cerebrovascular (CE) and bleeding events, as well as peri-procedural and long-term complications in a cohort of consecutive patients undergoing interventional LAAC using the WATCHMAN™ device, with focus on CKD patients. One hundred and eighty-nine consecutive patients undergoing interventional LAAC were included in this analysis; 171 (90.5%) patients had a reduced estimated glomerular filtration rate (eGFR; patients for each CKD stage: II = 66; IIIa = 32; IIIb = 43; IV = 18; V = 12). During a follow-up of 310 patient years three (1.0%) patients suffered a CE (two strokes, one transitory ischemic attack) and five (1.6%) other ones a bleeding complication. The observed stroke rate was more than two-thirds and the bleeding risk more than half lower than expected. Device related thrombi (DRT) were detected in twelve (6.5%) patients; women had significantly more DRT than men (12.5% vs. 2.6%; p = 0.009). Patients with an eGFR< 30 ml/min/1.73m2 showed a trend to a higher DRT rate as compared to the opposite group (13.3% vs. 5.1%; p = 0.10). Thrombus resolved with temporary oral anticoagulation therapy in ten patients without sequelae; thrombus consolidation was confirmed by serial TEE controls in the remaining two patients. Atrial fibrillation patients with CKD have low CE and bleeding rates after LAAC with the WATCHMAN™ device. DRT risk is higher in female and patients with severe CKD. More frequent post-interventional TEE controls might be justified for early DRT detection and safe management of patients at high DRT risk. (German Clinical Trials Register ID: DRKS00 010768 ; Registration Date 07.07.2016).
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Luani et al. (2019) studied this question.
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