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Outcomes of Left Atrial Appendage Occlusion in Anticoagulation Failure vs Contraindication
Session:
SESSÃO DE POSTERS 58 – TROMBOEMBOLISMO
Speaker:
Rita Ventura
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Rita Bertão Ventura; Mafalda Griné; Inês Brito e Cruz; Maria João Primo; Didier Martinez; Tomás Carlos; Luísa Rocha; Bernardo Resende; Manuel Oliveira-Santos; Luís Paiva; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Introduction:</strong> The failure of anticoagulation therapy in atrial fibrillation presents challenges in managing and preventing thromboembolic events.<span style="background-color:white"> Percutaneous </span>left atrial appendage occlusion (LAAO) offers mechanical cardioembolic protection and is a potential therapeutic option when anticoagulation therapy fails.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">This study aimed to evaluate the efficacy of LAAO in patients with thromboembolic events despite anticoagulation compared to those with contraindication to anticoagulation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Methods: </strong>A single-centre retrospective cohort stud<span style="background-color:white">y analysed p</span>atients who underwent LAAO between 2010 and 2023. Patients were classified into two groups: Group 1 (patients with contraindication to anticoagulation) and Group 2 (patients with thromboembolic events despite anticoagulation). The primary endpoint was the occurrence of new events at 1 year, divided into thrombotic (ischemic stroke, transient ischemic attack, systemic embolism, and atrial thrombus) or hemorrhagic. Secondary analyses assessed periprocedural complications and all cause-mortality at 30 days.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Results: </strong>A total of 191 patients (mean age 74.2 ± 8.8 years, 67.0% male) were included, with 161 (84.3%) assigned to Group 1 and 30 (15.7%) to Group 2. New events at 1 year were observed in 11 patients (6.8%) in Group 1 and 1 patient (3.3%) in Group 2, without significant difference (p=0.69). Group 1 had 7 hemorrhagic events (4.4%), while Group 2 had 1 (3.3%). There were 4 thrombotic events in Group 1 (2.5%) and none in Group 2. Periprocedural complications occurred less frequently in Group 1 (n=5, 3.1%) than Group 2 (n=4, 13.3%; p=0.04). Reported complications included device embolization (n=1, 0.6% Group1; n=0 Group 2), myocardial rupture (n=1, 0.6% Group1; n=0 Group 2), femoral hematoma (n=1, 0.6% Group1; n=2, 6.7% Group 2), appendage rupture (n=1, 0.6% Group1; n=1, 3.3% Group 2) and femoral artery pseudoaneurysm (n=1, 0.6% Group1; n=1, 3.3% Group 2). 30-day mortality was observed in 3 patients in Group 1 (1.9%) and 1 (3.3%) in Group 2, with no statistically significant difference (p=0.50).</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Conclusion: </strong>In a single centre cohort,<strong> </strong>there was no significant difference in thrombotic/hemorrhagic events after LAAO in patients referred due to anticoagulation contraindication or failure. In patients with anticoagulation failure, there were no thrombotic events after LAAO. These findings suggest that LAAO remains an important option for patients who experience new thromboembolic events despite anticoagulation therapy. </span></span></p>
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