Key result
Percutaneous left atrial appendage closure in 9 patients with prior intracranial haemorrhage and atrial fibrillation resulted in 0 ischaemic or haemorrhagic events over a mean 15-month follow-up.
Why the study?
Oral anticoagulant use in patients with atrial fibrillation and intracranial haemorrhage is controversial due to haemorrhagic stroke recurrence risk, making alternative strategies like percutaneous left atrial appendage closure important to evaluate.
Does percutaneous left atrial appendage closure prevent ischaemic and haemorrhagic events in patients with non-valvular atrial fibrillation and a history of intracranial haemorrhage?
Observational (n=9)
No
Does percutaneous left atrial appendage closure prevent ischaemic and haemorrhagic events in patients with non-valvular atrial fibrillation and a history of intracranial haemorrhage?
Left atrial appendage closure appears to be a safe and effective alternative to anticoagulation in patients with non-valvular atrial fibrillation and a history of intracranial haemorrhage, with no recurrent events observed over 15 months.
Hypothesis-generating for LAA closure after intracranial haemorrhage in AF; larger trials needed before practice change.
The use of oral anticoagulants in patients with a history of atrial fibrillation (AF) and intracranial haemorrhage (ICH) is controversial on account of the risk of haemorrhagic stroke recurrence. This study presents our experience regarding the safety and efficacy of percutaneous left atrial appendage closure (LAAC), an alternative to anticoagulation in these patients. We conducted a retrospective, single-centre, observational study. LAAC was performed in patients with a history of ICH and non-valvular AF. Risk of ischaemic and haemorrhagic events was estimated using the CHA2DS2-VASc and HAS-BLED scales. We recorded periprocedural complications, IHC recurrence, cerebral/systemic embolism, mortality and use of antithrombotic drugs following the procedure. LAAC was performed in 9 patients (7 men, 2 women) using the AMPLATZER Amulet device in 7 cases and the AMPLATZER Cardiac Plug device in 2. Mean age was 72.7 ± 8.2 years. Time between ICH and LAAC was less than one month in 5 patients and more than one month in 4 patients. Median CHA2DS2-VASc score was 4 (interquartile range of 2.5). Median HAS-BLED score was 3 (interquartile range of 0). No periprocedural complications were recorded. All patients received single anti-platelet therapy (clopidogrel in 5 patients, aspirin in 4) after the procedure; 5 patients received this treatment for 6 months and 4 received it indefinitely. No ischaemic or haemorrhagic events were recorded during follow-up (mean duration of 15 months). In our series, LAAC was found to be safe and effective in patients with a history of ICH who required anticoagulation due to AF. El uso de anticoagulantes orales es controvertido en pacientes con antecedentes de fibrilación auricular (FA) y hemorragia intracraneal (HIC), por riesgo de recurrencia de ictus hemorrágico. Presentamos la experiencia de nuestro centro en relación con la seguridad y la eficacia del cierre percutáneo de orejuela (CPO), una alternativa a la anticoagulación en dicho contexto. Estudio observacional, retrospectivo y unicéntrico. El CPO se realizó en pacientes con antecedentes de HIC y FA no valvular. El riesgo de eventos isquémicos y hemorrágicos se estimó usando las escalas CHA2DS2Vasc y HAS-BLED. Se registraron: complicaciones periprocedimiento, recurrencia de HIC, embolismo cerebral/sistémico, mortalidad tras el cierre y al seguimiento y uso de antitrombóticos tras el procedimiento. El CPO se realizó en 9 pacientes (7 hombres, 2 mujeres). Se utilizó en 7 casos el dispositivo Amplatzer Amulet y en 2 el Amplatzer Cardiac Plug. La media de edad fue 72,7 ± 8,2 años. El tiempo entre la HIC y el CPO fue menor de un mes en 5 pacientes y mayor en 4. La mediana y el rango intercuartil para la escala CHA2DS2Vasc fueron de 4 y 2,5, respectivamente, siendo de 3 y 0 para la escala HAS-BLED. No hubo complicaciones periprocedimiento. Todos recibieron antiagregación simple tras el procedimiento (5 clopidogrel y 4 aspirina); en 5 se mantuvo 6 meses, en 4 indefinidamente. Durante el seguimiento (15 meses de promedio) no se registraron eventos isquémicos ni hemorrágicos. En nuestra serie, el CPO supone una alternativa segura y eficaz en pacientes que han presentado HIC y que precisan ser anticoagulados por FA.
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Fayos-Vidal et al. (2019) conducted an observational in Intracranial haemorrhage and non-valvular atrial fibrillation (n=9). Percutaneous left atrial appendage closure (LAAC) was evaluated on Ischaemic or haemorrhagic events. Percutaneous left atrial appendage closure in 9 patients with prior intracranial haemorrhage and atrial fibrillation resulted in 0 ischaemic or haemorrhagic events over a mean 15-month follow-up.
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