Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure
Marroquin, Luis (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)
Tirado-Conte, Gabriela (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)
Pracoń, Radosław (National Institute of Cardiology (Varsòvia, Polònia))
Streb, Witold (Silesian Centre for Heart Disease (Zabrze, Polònia))
Gutierrez, Hipolito (Hospital Clínico Universitario de Valladolid)
Boccuzzi, Giacomo (Ospedale San Giovanni Bosco. Cardiology)
Arzamendi, Dabit (Institut d'Investigació Biomèdica Sant Pau)
Cruz-González, Ignacio (Hospital Universitario de Salamanca)
Ruiz Nodar, Juan Miguel (Hospital General Universitario de Alicante (Alacant, País Valencià))
Kim, Jung-Sun (Severance Cardiovascular Hospital)
Freixa, Xavier (Hospital Clínic i Provincial de Barcelona)
Lopez Minguez, José Ramón (Hospital Universitario de Badajoz)
De Backer, Ole (Rigshospitalet. Cardiology (Dinamarca))
Ruiz-Salmeron, Rafael (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Dominguez, Antonio (Hospital Universitario Virgen de la Victoria (Màlaga, Andalusia))
McInerney, Angela (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)
Peral, Vicente (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Estevez-Loureiro, Rodrigo (Complexo Hospitalario Universitario de Vigo)
Fernandez-Nofrerias, Eduard (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Freitas-Ferraz, Afonso B. (Cardiology. Quebec Heart and Lung Institute. Laval University)
Saia, Francesco (University Hospital of Bologna)
Huczek, Zenon (Medical University of Warsaw (Polònia))
Gheorghe, Livia (Hospital Universitario Puerta del Mar (Cadis, Andalusia))
Salinas, Pablo (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)
Demkow, Marcin (National Institute of Cardiology (Varsòvia, Polònia))
Delgado-Arana, Jose Raul (Hospital Clínico Universitario de Valladolid)
Fernandez Peregrina, E. (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Kalarus, Zbibniew (Silesian Centre for Heart Disease (Zabrze, Polònia))
Elvira Laffond, Ana (Hospital Universitario de Salamanca)
Jang, Yangsoo (Severance Cardiovascular Hospital (Yonsei, República de Corea))
Fernandez Camacho, Jose Carlos (Hospital Universitario de Badajoz)
Lee, Oh-Hyun (Severance Cardiovascular Hospital (Yonsei, República de Corea))
Hernández-Garcia, Jose M. (Hospital Universitario Virgen de la Victoria (Màlaga, Andalusia))
Mas-Llado, Caterina (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Caneiro-Queija, Berenice (Complexo Hospitalario Universitario de Vigo)
Amat-Santos, Ignacio J (Hospital Clínico Universitario de Valladolid)
Dabrowski, Maciej (National Institute of Cardiology. Interventional Cardiology and Angiology Clinic (Warsaw, Polònia))
Rodes-Cabau, Josep (Laval University. Quebec Heart and Lung Institute (Canadà))
Nombela-Franco, Luís (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos)

Fecha:	2023
Resumen:	Objective: Left atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus. Methods: This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively. Results: IAT was the preferred strategy in 57. 9% of patients, with total thrombus resolution observed in 60. 3% and 75. 3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9. 6% and 2. 9%, respectively, compared with 3. 8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90. 5% (96. 2% vs 86. 3% in direct LAAC and IAT group, respectively, p=0. 072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29. 3% and device-related thrombosis was found in 12. 8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22. 5% vs 10. 5% in the IAT and direct LAAC group, respectively (p=0. 102). Conclusion: In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (∼10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up.
Nota:	Altres ajuts: Fundación Interhospitalaria para la Investigación Cardiovascular (FIC Foundation); Abbott.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Publicado en:	Heart, 2023 , ISSN 1468-201X

DOI: 10.1136/heartjnl-2021-319811
PMID: 34686564

9 p, 1.9 MB

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