Major Bleeding Predictors in Patients with Left Atrial Appendage Closure : The Iberian Registry II
López-Mínguez, José Ramón (Hospital Universitario de Badajoz)
Nogales-Asensio, Juan Manuel (Hospital Universitario de Badajoz)
Infante De Oliveira, Eduardo (Hospital de Santa María, 1649-028 Lisbon, Portugal)
Santos, Lino (Centro Hospitalario de Vila Nova de Gaia, 4430-999 Vila Nova de Gaia Oporto, Portugal)
Ruiz-Salmerón, Rafael (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Arzamendi, Dabit (Institut d'Investigació Biomèdica Sant Pau)
Costa, Marco (Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal)
Gutiérrez-García, Hipólito (Hospital Clínico Universitario de Valladolid)
Fernández-Díaz, Jose Antonio (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Freixa, Xavier (Hospital Clínic i Provincial de Barcelona)
Cruz-González, Ignacio (Hospital Universitario de Salamanca)
Moreno, Raúl (Hospital Universitario La Paz (Madrid))
Íñiguez-Romo, Andrés (Hospital Álvaro Cunqueiro (Vigo))
Alfonso, Fernando (Hospital Universitario de la Princesa (Madrid))
Universitat Autònoma de Barcelona

Date:	2020
Abstract:	Introduction and objective: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2. 2 to 10. 3 per 100 patient-years in different series. This study aimed to clarify the bleeding predictive factors that could influence these differences. Methods: LAAC was performed in 598 patients from the Iberian Registry II (1093 patient-years; median, 75. 4 years). We conducted a multivariate analysis to identify predictive risk factors for major bleeding events. The occurrence of thromboembolic and bleeding events was compared to rates expected from CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drugs or alcohol) scores. Results: Cox regression analysis revealed that age ≥75 years (HR: 2. 5; 95% CI: 1. 3 to 4. 8; p = 0. 004) and a history of gastrointestinal bleeding (GIB) (HR: 2. 1; 95% CI: 1. 1 to 3. 9; p = 0. 020) were two factors independently associated with major bleeding during follow-up. Patients aged <75 or ≥75 years had median CHA2DS2-VASc scores of 4 (IQR: 2) and 5 (IQR: 2), respectively (p < 0. 001) and HAS-BLED scores were 3 (IQR: 1) and 3 (IQR: 1) for each group (p = 0. 007). Events presented as follow-up adjusted rates according to age groups were stroke (1. 2% vs. 2. 9%; HR: 2. 4, p = 0. 12) and major bleeding (3. 7 vs. 9. 0 per 100 patient-years; HR: 2. 4, p = 0. 002). Expected major bleedings according to HAS-BLED scores were 6. 2% vs. 6. 6%, respectively. In patients with GIB history, major bleeding events were 6. 1% patient-years (HAS-BLED score was 3. 8 ± 1. 1) compared to 2. 7% patients-year in patients with no previous GIB history (HAS-BLED score was 3. 4 ± 1. 2; p = 0. 029). Conclusions: In this high-risk population, GIB history and age ≥75 years are the main predictors of major bleeding events after LAAC, especially during the first year. Age seems to have a greater influence on major bleeding events than on thromboembolic risk in these patients.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Atrial fibrillation ; Bleeding risk ; Age ; Left atrial appendage closure
Published in:	Journal of clinical medicine, Vol. 9 (july 2020) , ISSN 2077-0383

DOI: 10.3390/jcm9072295
PMID: 32707736

11 p, 887.1 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles