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Journal of Interventional Cardiology
Volume 2019, Article ID 6704031, 7 pages
https://doi.org/10.1155/2019/6704031
Research Article

Left Atrial Appendage Occlusion in High Bleeding Risk Patients

1Department of Cardiology, Ospedale San Francesco, Nuoro, Italy
2Istituto di Clinica Medica, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
3Neurology Department and Stroke Unit, Ospedale San Francesco, Nuoro, Italy
4Arrhythmology and Cardiac Pacing Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy

Correspondence should be addressed to Pierluigi Merella; ti.liamtoh@9igiulreip

Received 20 May 2018; Revised 27 January 2019; Accepted 6 February 2019; Published 18 February 2019

Academic Editor: Andrea Rubboli

Copyright © 2019 Pierluigi Merella et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives. The aim of this study was to investigate the outcomes of left atrial appendage occlusion (LAAO) in high bleeding risk patients suffering atrial fibrillation (AF) and to analyze the different antithrombotic therapies following the intervention. Background. Methods. This monocentric study included 68 patients with nonvalvular AF with an absolute contraindication to OAT or at high bleeding risk. Follow-up was done with a clinical visit at 3-6-12 months. Results. Successful LAAO was achieved in 67/68 patients. At discharge, 32/68 patients were on dual antiplatelet therapy (APT), 34/68 were without any antithrombotic therapy or with a single antiplatelet drug, and 2/68 were on anticoagulant therapy. At three-month follow-up visit, 73.6% of the patients did not receive dual APT, of whom 14.7% had no thrombotic therapy and 58.9% were on single antiplatelet therapy. During a follow-up of 1.4 ± 0.9 years, 3/62 patients had late adverse effects (2 device-related thrombus without clinical consequences and 1 extracranial bleeding). The device-related thrombosis was not related to the antithrombotic therapy. Conclusions. LAAO is feasible and safe and prevents stroke in patients with AF with contraindication to oral anticoagulant therapy. After LAAO, single antiplatelet therapy seems to be a safe alternative to dual antiplatelet therapy, especially in patients at high bleeding risk. No benefit has been observed with dual APT.