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Safety of percutaneous left atrial appendage closure with the amplatzer cardiac plug in patients with atrial fibrillation and contraindications to anticoagulation
Author(s) -
Wiebe Jens,
Bertog Stefan,
Franke Jennifer,
Wettstein Olga,
Lehn Katharina,
Hofmann Ilona,
Vaskelyte Laura,
Sievert Horst
Publication year - 2014
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25329
Subject(s) - medicine , atrial fibrillation , warfarin , stroke (engine) , percutaneous , surgery , cardiology , thromboembolic stroke , mechanical engineering , engineering
Objective To evaluate the safety of percutaneous left atrial appendage (LAA) closure with the Amplatzer Cardiac Plug (ACP) in patients with nonvalvular atrial fibrillation (AF) who are not eligible for oral anticoagulation with warfarin. Background Anticoagulation is the treatment of choice for prevention of strokes in patients with AF, but some patients have contraindications to anticoagulation. Methods A total of 60 patients with a CHA 2 DS 2 ‐VASc score of at least 1 and contraindications to warfarin who underwent percutaneous LAA closure with the ACP were included. Stroke risk assessment was performed with the CHADS 2 and CHA 2 DS 2 ‐VASc score and the bleeding risk was calculated with the HAS‐BLED‐score. Follow‐up included office visits, telephone inquiries, and mail contact. Results Mean CHADS 2 ‐, CHA 2 DS 2 ‐VASc‐, and HAS‐BLED scores were 2.6 (± 1.4), 4.3 (± 1.7), and 3.3 (± 1.0), respectively. Twenty‐five percent had a history of previous bleeding without oral anticoagulation and 63.3% while receiving oral anticoagulation. In 36.7% other contraindications to warfarin were present. Procedural success was achieved in 95%. Mean follow‐up time was 1.8 (1.0–2.8) years. The estimated annual stroke risk based on the CHADS 2 ‐score was 5.8%. The estimated annual bleeding risk on warfarin based on the HAS‐BLED score was 3.7%. During follow‐up, the annual incidence of stroke was 0%. Major bleeding complications occurred in 1.9% annually. Conclusions Percutaneous LAA closure with the ACP in patients with contraindications to oral anticoagulation is safe. The stroke and bleeding risk after percutaneous LAA closure is lower than predicted by conventional risk scores. © 2013 Wiley Periodicals, Inc.