Midterm follow-up and anticoagulation management after left atrial appendage closure

Abstract

Percutaneous left atrial appendage closure (LAAC) is accepted as a valuable solution for patients (pts) with atrial fibrillation and high thromboembolic risk in case of contra-indication to oral anticoagulation (OA). Post-procedure anticoagulation schemes used in reference studies usually cannot be provided in these patients, and little is known about anticoagulation management and complications in the real life setting. We analyzed midterm results in LAAC closure in a dedicated electrophysiological team. All indications were discussed before the procedure in a multidisciplinary approach, with particular concerns in postoperative anticoagulation schemes. All LAAC procedures were performed with watchman devices. Ninety-one patients were enrolled (male 58%, 77 ± 6 years). The CHADS 2 VASc average score was 4.7 ± 1.3, HASBLED score was 3.7 ± 1. All indications were definitive contra-indications for OA due to hemorrhagic events (neurological 68%, gastrointestinal 17%, ENT 3%, other 11%). The CT-scan ruled out any thrombus before the procedure for all patients with a perioperative TEE confirmation. Success rate of implantation was 99%. There were no periprocedure complications except one arteriovenous femoral fistula. Discharge postoperative therapy was: antiagregation (AA) 48%, double AA 20%, OA 8%, OA + AA 3%, heparin 14%, heparin + AA 3%, none 4%. After 45 days, and TEE control, the initial treatment was switched to: AA 40%, double AA 3%, OA 0%, none 57%. Midterm complications were: pulmonary embolism n = 1, recurrent non-severe hemorrhagic stroke n = 1, recurrent gastrointestinal hemorrhagic event n = 1, TIA due to carotid stenosis n = 1, ischemic stoke n = 2 (patient 1 at 7.3 month follow-up (FU), no therapy and patient 2 at 11.6 month FU, AA therapy). There were no other adverse events during 19.5 ± 11 month FU. In a single center EP team, LAAC was performed with a low rate of complications and good midterm results using a tailored and individual anticoagulation approach.