Device-Related Thrombosis After Percutaneous Left Atrial Appendage Occlusion for Atrial Fibrillation
Laurent Fauchier, Alexandre Cinaud, François Brigadeau, Antoine Lepillier, Bertrand Pierre, Selim Abbey, Marjaneh Fatemi, Frederic Franceschi, Paul Guedeney, Peggy Jacon, Olivier Paziaud, Sandrine Venier, Jean Claude Deharo, Daniel Gras, Didier Klug, Jacques Mansourati, Gilles Montalescot, Olivier Piot, Pascal Defaye, Laurent Fauchier, Alexandre Cinaud, François Brigadeau, Antoine Lepillier, Bertrand Pierre, Selim Abbey, Marjaneh Fatemi, Frederic Franceschi, Paul Guedeney, Peggy Jacon, Olivier Paziaud, Sandrine Venier, Jean Claude Deharo, Daniel Gras, Didier Klug, Jacques Mansourati, Gilles Montalescot, Olivier Piot, Pascal Defaye
Abstract
Background: Transcatheter left atrial appendage (LAA) occlusion is an alternative strategy for stroke prevention in patients with atrial fibrillation (AF).
Objectives: This study sought to determine the incidence, predictors, and prognosis of thrombus formation on devices in patients with AF who were treated with LAA closure.
Methods: The study retrospectively analyzed data from patients treated with 2 LAA closure devices seen in 8 centers in France from February 2012 to January 2017.
Results: A total of 469 consecutive patients with AF underwent LAA closure (272 Watchman devices [Atritech, Boston Scientific, Natick, Massachusetts] and 197 Amplatzer devices [St. Jude Medical, Minneapolis, Minnesota]). Mean follow-up was 13 ± 13 months, during which 339 (72.3%) patients underwent LAA imaging at least once. There were 98 major adverse events (26 thrombi on devices, 19 ischemic strokes, 2 transient ischemic attacks, 18 major hemorrhages, 33 deaths) recorded in 89 patients. The incidence of device-related thrombus in patients with LAA imaging was 7.2% per year. Older age (hazard ratio [HR]: 1.07 per 1-year increase; 95% confidence interval [CI]: 1.01 to 1.14; p = 0.02) and history of stroke (HR: 3.68; 95% CI: 1.17 to 11.62; p = 0.03) were predictors of thrombus formation on the devices, whereas dual antiplatelet therapy (HR: 0.10; 95% CI: 0.01 to 0.76; p = 0.03) and oral anticoagulation at discharge (HR: 0.26; 95% CI: 0.09 to 0.77; p = 0.02) were protective factors. Thrombus on the device (HR: 4.39; 95% CI: 1.05 to 18.43; p = 0.04) and vascular disease (HR: 5.03; 95% CI: 1.39 to 18.23; p = 0.01) were independent predictors of ischemic strokes and transient ischemic attacks during follow-up.
Conclusions: Thrombus formation on the device is not uncommon in patients with AF who are treated by LAA closure. Such events are strongly associated with a higher risk of ischemic stroke during follow-up. (REgistry on Real-Life EXperience With Left Atrial Appendage Occlusion [RELEXAO]; NCT03279406).
Keywords: antithrombotic therapy; embolism; stroke; thrombus on device; transesophageal echocardiography; transient ischemic attack.
Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed