Abstract
Objectives: The purpose of this study was to provide data on the long-term efficacy and safety of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) and chronic thrombocytopenia (cTCP).Methods: Between January 2016 and December 2018, a total of 32 AF patients with thrombocytopenia (platelet count <100*10∧9/L) undergoing LAAO at our center were identified and their outcomes were compared with a propensity-matched cohort (match ratio 1:5) of patients without cTCP who had also been indicated for LAAO.Results: Between the cTCP patients and the control group, no difference was found on the incidence of stroke (0 vs. 3.13%, p = 0.592), systematic thromboembolisation (0 vs. 0.63%, p > 0.9) and device-related thrombus (DRT) (3.13 vs. 2.50%, p > 0.9). Major (12.50 vs. 3.75%, p = 0.065) and minor bleeding (15.63 vs. 1.25%, p = 0.002) was more frequent in cTCP patients but no statistical difference was reached in major bleeding. Moreover, thrombocytopenia was also identified as an independent predictor of any bleeding events (OR: 8.150, 95% CI: 2.579–25.757, p < 0.001), while an inverse relationship between higher absolute platelet count and stroke events was revealed (OR: 1.015; 95% CI: 1.002~1.029, p = 0.022). However, in both groups we saw a significant reduction in observed annualized rates of non-procedural complications compared with the predicted values. In the cTCP and control groups, clinical thromboembolism was reduced by 100 and 74.32%, and major bleeding by 42.47 and 71.67%, respectively.Conclusion: Our preliminary results indicate that LAAO using the Watchman device could be a safe and effective means of preventing stroke in AF patients with or without thrombocytopenia, but bleeding complications should be monitored intensively in cTCP patients.
Highlights
Thrombocytopenia, usually defined as a platelet count lower than 100∗10∧9/L, is estimated to account for ∼6–24% of patients with AF [1, 2]
Given their chronic exposure to stroke, high bleeding risk, and therapeutic decisions to consider, there is a significant need for management in AF patients with thrombocytopenia in order to counterbalance the benefits with the risks of complications
The primary findings of this study are: [1] The procedure of LAA implantation could be safely applied in patients with platelet count
Summary
Thrombocytopenia, usually defined as a platelet count lower than 100∗10∧9/L, is estimated to account for ∼6–24% of patients with AF [1, 2]. Given the increased mortality rates, thrombocytopenic patients were excluded from most randomized controlled trials using non-vitamin-K antagonist oral anticoagulants (NOACs) or warfarin [5,6,7]. Several observational studies have demonstrated a higher incidence of bleeding events among thrombocytopenic patients [8,9,10]. The current guidelines for AF management have addressed no definite recommendations for this special population [11]. Given their chronic exposure to stroke, high bleeding risk, and therapeutic decisions to consider, there is a significant need for management in AF patients with thrombocytopenia in order to counterbalance the benefits with the risks of complications. The purpose of the present study was to prospectively estimate the safety and efficacy of LAA implantation during mid- to long-term follow-up
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