Key result
Percutaneous left atrial appendage closure demonstrated a 100% procedural success rate in hemodialysis patients, with no significant difference in major complications compared to non-hemodialysis patients at 45 days.
Why the study?
In countries where anticoagulation is not recommended in hemodialysis patients, the feasibility of percutaneous LAAC in hemodialysis patients with NVAF and high risks of thromboembolic stroke and bleeding remains unknown.
Does percutaneous left atrial appendage closure have comparable safety and short-term feasibility in hemodialysis patients compared to non-hemodialysis patients with non-valvular atrial fibrillation and high bleeding risk?
Cohort (n=118)
No
Does percutaneous left atrial appendage closure have comparable safety and short-term feasibility in hemodialysis patients compared to non-hemodialysis patients with non-valvular atrial fibrillation and high bleeding risk?
Percutaneous left atrial appendage closure appears feasible and safe in the short term for hemodialysis patients with non-valvular atrial fibrillation and high bleeding risk.
Answers are grounded in this paper and cite their sources.
May support LAAC feasibility in high-risk Japanese hemodialysis patients with NVAF; hypothesis-generating and leaves open need for prospective trials.
In the countries like Japan where anticoagulation is not recommended in hemodialysis patients, the feasibility of percutaneous left atrial appendage closure (LAAC) in hemodialysis patients with non-valvular atrial fibrillation (NVAF) accompanying high risks of thromboembolic stroke and bleeding remains unknown. Peri-procedural and 45-day clinical outcomes following LAAC using WATCHMAN system, which were performed in our institute between Jun 2020 and April 2022 according to the Japanese Circulation Society guidelines, were retrospectively compared between those with and without hemodialysis. 118 patients (median 79 years, 81 men) consisting of 25 hemodialysis patients and 93 non-hemodialysis patients were included. CHADS score was 3 (2, 4) in the hemodialysis patients and 3 (2, 4) in the non-hemodialysis patients (p = 0.98). HAS-BREAD score was 4 (3, 5) in the hemodialysis patients and 3 (2, 3) in the non-hemodialysis patients (p < 0.001). All procedures were successful, except for a non-hemodialysis patient with a larger left atrial appendage. There were no major complications during index hospitalization and 45-day observational period, except for a hemodialysis patient with suspected bleeding and a non-hemodialysis patient who died due to cardiac amyloidosis. LAAC seems to be feasible in hemodialysis patients with high risks of thromboembolic events and bleedings.
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Ueno et al. (2022) conducted a cohort in Non-valvular atrial fibrillation with high risk of bleeding (n=118). Hemodialysis (in patients undergoing left atrial appendage closure) vs. Non-hemodialysis was evaluated on Procedure success (p=0.60). Percutaneous left atrial appendage closure demonstrated a 100% procedural success rate in hemodialysis patients, with no significant difference in major complications compared to non-hemodialysis patients at 45 days.
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