Page 48 - Journal of Structural Heart Disease Volume 2, Issue 1

Meeting Abstracts
Journal of Structural Heart Disease, April 2016, Volume 2, Issue 1: 42-43
DOI: http://dx.doi.org/10.12945/j.jshd.2016.004.16
PICS CSI Asia Dubai Abstracts 2016
Catheter Interventions in Congenital, Structural and Valvular Heart Disease
Published online: April 2016
http://www.csi-congress.org/pics-csi-asia http://www.picsymposium.com
ANTITHROMBOTIC TREATMENT AFTER PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE: A DIFFICULT CHALLENGE IN PATIENTS AT HIGH RISK OF BLEEDING Daniele Gemma1, Guillermo Galeote García1, Raúl Moreno Gómez1, Javier De Juan Bagudá2, Natalia Lorenzo Muñoz3, Ignacio Plaza Pérez2, Inés Ponz de Antonio1, José Luis López Sendón1
1 Hospital Universitario La Paz, Madrid, Spain
2 Hospital Infanta Sofía, Madrid, Spain
3 Hospital Infanta Cristina, Parla (Madrid), Spain
Background: Contraindication to oral anticoagulation (OAC) is the main indication for percutaneous left atrial appendage closure (PLAAC). This implies a challenge in deciding the adequate anti- thrombotic therapy after device implantation.
Objectives: The aim of our study is to assess whether the type of an- tithrombotic treatment is related to thromboembolic/bleeding risk after PLACC.
Methods: Retrospective observational study including patients with
atrial brillation who underwent PLAAC with AmplatzerTM device for OAC contraindication in our centre, until April 2015. Major bleeding was de ned as intracranial bleeding, decrease in Hb 2 g/L and/or transfusion requirement, and minor bleeding as any other kind of bleeding.
Results: 18 patients were included (mean age 75 years, HASBLED 4). After PLAAC, control transesophageal echocardiography was per- formed in 14 patients; 12 patients (66.6%) received dual antiplatelet therapy (DAPT), 3 (16.7%) single antiplatelet therapy (SAPT), 3 (16.7%) apixaban for 3 months. No device thrombosis was observed. Bleeding was observed in 5 cases (3 major, 2 minor), 4 of them in the rst year, with an annual rate of major bleeding in the rst year higher than expected by the HASBLED score (11.1% vs. 8.9%). 2 major bleedings occurred under DAPT, while the 2 minor bleedings occurred under SAPT. No bleeding was observed under apixaban. The only parameter associated with major bleeding was DAPT at discharge (p=0.001).
Conclusions: In our series DAPT after PLAAC was associated with a higher rate of bleeding complications. We didn´t observe device thrombosis. Further studies are needed to nd the optimal ant thrombotic regimen after implantation.
Nothing
M Acetylsalicylic acid 100 mg + Clopidogrel 75
Acetylsalicylic acid 100 mg + Clopidogrel 75
Acetylsalicylic acid 100 mg Acetylsalicylic acid 100 mg
Table 1.
Major bleeding
Minor bleeding
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Kind of bleeding
Age
Gender
HAS-BLED score
Time from intervention (months)
Antithrombotic treatment
Esophageal varices (Exitus)
82
M
5
30
Intracranial (Exitus)
65
M
5
2
Intestinal
( Transfusions)
74
M
4
1
Haematuria
77
M
5
9
Epistaxis
93
F
3
6