Percutaneous left atrial appendage closure in patients with primary hemostasis disorders and atrial fibrillation

摘要

Abstract Background or purpose We report our single-center experience with percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) and primary hemostasis disorders (HD).Methods Consecutive patients with primary HD who underwent a percutaneous LAAC were included. Baseline characteristics, procedural data, and clinical outcomes were prospectively collected and compared with the overall LAAC cohort without HD.Results Since 2013, among 229 LAAC, 17 patients (7%) had a primary HD: thrombocytopenia (n?=?5), myelodysplastic syndrome (n?=?6), von Willebrand syndrome (n?=?4), type A hemophilia (n?=?1), and dysfibrinogenemia (n?=?1). The HD population’s age ranged from 61 to 87?years, and the median CHA2DS2VASc was 5. Periprocedural plasmatic management was required in 47% of patients. The immediate LAAC implantation success rate was 100%. Patients received a direct oral anticoagulant (DOA) (n?=?9), dual antiplatelet (n?=?6), aspirin (n?=?1), or no therapy (n?=?1) during the first six postoperative weeks, followed with single antiplatelet (n?=?16) or no therapy (n?=?1) during lifelong. After 20?months, the technical success rate and procedural success rate were 100% and 94%. Zero device-/procedure-related complication and only one life-threatening bleeding occurred. Compared to patients without HD (n?=?212), a baseline history of bleeding was less frequent (53% vs 91%, p?