Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(11), 1337–1344. https://doi.org/10.1002/clc.24123 Dr. Christian Schach et al.
Points
- Left atrial appendage closure (LAAC) was studied as a mechanical alternative for stroke prevention in atrial fibrillation (AF) patients intolerant to oral anticoagulation (OAC).
- The research analyzed 75 high-risk AF patients and found that LAAC significantly reduced bleeding events, decreasing from 1.8 ± 1.4 to 0.6 ± 2.1 events per year and stabilizing the need for transfusions.
- The occurrence of stroke also decreased significantly after LAAC, from 14 patients before the procedure to 3 patients after, highlighting the procedure’s efficacy in stroke prevention.
- Serum hemoglobin levels substantially increased from 9.9 ± 3.0 to 11.9 ± 2.3 g/dL by the end of the follow-up period, indicating a positive impact on hematological parameters.
- The study’s findings support the potential of LAAC as a valuable intervention for stroke prevention in high-risk AF patients intolerant to OAC, offering a promising alternative for this challenging patient population.
Summary
The study investigated the impact of left atrial appendage closure (LAAC) on bleeding events, serum hemoglobin levels, and stroke occurrence in a high-risk cohort of atrial fibrillation (AF) patients intolerant to oral anticoagulation (OAC). The research hypothesized that reducing anticoagulation following LAAC would lead to a decrease in bleeding events and an increase in serum hemoglobin levels. The analysis encompassed 75 patients with a mean CHA₂DS₂-VASc score of 4.4 ± 1.7 and a mean HAS-BLED score of 4.6 ± 1.1. Before LAAC, the patients experienced significant bleeding events, with 67 patients encountering 1.8 ± 1.4 bleeding events (0.9 ± 1.3 major) per year, resulting in 0.7 ± 1.3 transfusions per year. Following LAAC, there was a notable reduction in bleeding events, with 26 patients experiencing 0.6 ± 2.1 bleeding events (0.2 ± 0.6 major) per year (p < .0001 vs. before), and the need for transfusions remained stable. Additionally, the occurrence of stroke decreased significantly after LAAC, from 14 patients before the procedure to 3 patients after (p = .008). Serum hemoglobin levels also substantially increased from 9.9 ± 3.0 to 11.9 ± 2.3 g/dL by the end of the follow-up period (p = .0005).
The findings from this study demonstrate the beneficial effects of LAAC in reducing the incidence of bleeding events and stroke in AF patients with a high risk for stroke who are intolerant to OAC. The significant decrease in bleeding events and the rise in serum hemoglobin levels following LAAC underscore the potential of this mechanical alternative for stroke prevention in patients who cannot tolerate OAC. The results provide valuable insights into the clinical relevance of LAAC in managing high-risk AF patients, highlighting its potential to improve patient outcomes and quality of life.
In summary, the study’s comprehensive analysis of the impact of LAAC on bleeding events, serum hemoglobin levels, and stroke occurrence in high-risk AF patients provides compelling evidence of the procedure’s efficacy in reducing adverse events and improving hematological parameters. The findings support the potential of LAAC as a valuable intervention for stroke prevention in patients intolerant to OAC, offering a promising alternative for this challenging patient population.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24123
References Schach, C., Reitschuster, R., Benedikt, D., Füssl, E., Debl, K., Maier, L. S., & Luchner, A. (2023). Less major bleeding and higher hemoglobin after left atrial appendage closure in high‐risk patients: Data from a long‐term, longitudinal, two‐center observational study. Clinical Cardiology, 46(11), 1337–1344. https://doi.org/10.1002/clc.24123
