Incidence and Predictors of Clinically Significant Bleedings after Transcatheter Left Atrial Appendage Closure

Kamil Zieliński (), Radosław Pracoń, Marek Konka, Mariusz Kruk, Cezary Kępka, Piotr Trochimiuk, Mariusz Dębski, Edyta Kaczmarska, Jakub Przyłuski, Ilona Kowalik, Zofia Dzielińska, Andrzej Kurowski, Adam Witkowski and Marcin Demkow
Additional contact information
Kamil Zieliński: Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Radosław Pracoń: Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Marek Konka: Department of Congenital Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Mariusz Kruk: Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Cezary Kępka: Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Piotr Trochimiuk: Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Mariusz Dębski: Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Edyta Kaczmarska: Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Jakub Przyłuski: Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Ilona Kowalik: Clinical Research Support Center, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Zofia Dzielińska: Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Andrzej Kurowski: Department of Anesthesiology, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Adam Witkowski: Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
Marcin Demkow: Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland

IJERPH, 2022, vol. 19, issue 21, 1-12

Abstract: Background: Transcatheter left atrial appendage closure (LAAC) is performed in patients unsuitable for long-term anticoagulation, predominantly due to prior bleeding events. The study aimed to investigate the incidence and predictors of clinically significant bleeding (CSB) post-LAAC. Methods: Consecutive patients after LAAC with an Amplatzer or WATCHMAN device were analyzed (05.2014–11.2019). Bleeding was classified as CSB when associated with at least one of the following: death, ≥2 g/dL hemoglobin drop, ≥2 blood units transfusion, critical anatomic site, or hospitalization/invasive procedure. Results: Among 195 patients (age 74 (68–80), 43.1% females, HAS-BLED score 2.0 (2.0–3.0)), during median follow-up of 370 (IQR, 358–392) days, there were 15 nonprocedural CSBs in 14 (7.2%) patients. Of those, 9 (60.0%) occurred during postprocedural dual antiplatelet therapy (DAPT) (median 46 (IQR: 16–60) days post-LAAC) vs. 6 (40%) after DAPT discontinuation (median 124 (81–210) days post-LAAC), translating into annualized CSB rates of 14.0% (per patient-year on DAPT) vs. 4.6% (per patient-year without DAPT). In 92.9% (13/14) of patients, the post-LAAC nonprocedural CSB was a recurrence from the same site as bleeding pre-LAAC. In the multivariable model, admission systolic blood pressure (SBP) > 127 mmHg (HR = 10.73, 1.37–84.26, p = 0.024), epistaxis history (HR = 5.84, 1.32–25.89, p = 0.020), permanent atrial fibrillation (AF) (HR = 4.55, 1.20–17.20, p = 0.025), and prior gastrointestinal bleeding (HR = 3.35, 1.01–11.08, p = 0.048) predicted post-LAAC CSB. Conclusions: Nonprocedural CSBs after LAAC, with a similar origin as the pre-LAAC bleedings, were observed predominantly during postprocedural DAPT and predicted by elevated admission SBP, prior epistaxis, permanent AF, and gastrointestinal bleeding history. Whether a more reserved post-LAAC antiplatelet regimen and stringent blood pressure control may improve LAAC outcomes remains to be studied.

Keywords: left atrial appendage closure; bleeding; stroke; atrial fibrillation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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