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Article

Major Bleeding Predictors in Patients with Left Atrial Appendage Closure: The Iberian Registry II

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Cardiology Department, Interventional Cardiology Section, Hospital Universitario de Badajoz, 06080 Badajoz, Spain
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Cardiology Department, Interventional Cardiology Section, Hospital de Santa María, 1649-028 Lisbon, Portugal
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Cardiology Department, Interventional Cardiology Section, Centro Hospitalario de Vila Nova de Gaia, 4430-999 Vila Nova de Gaia Oporto, Portugal
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Cardiology Department, Interventional Cardiology Section, Hospital Virgen de la Macarena, 41009 Seville, Spain
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Cardiology Department, Interventional Cardiology Section, Hospital Santa Creu i San Pau, 08041 Barcelona, Spain
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Cardiology Department, Interventional Cardiology Section, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
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Cardiology Department, Interventional Cardiology Section, Hospital Clínico de Valladolid, 47003 Valladolid, Spain
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Cardiology Department, Interventional Cardiology Section, Hospital Puerta de Hierro, Majadahona, 28222 Madrid, Spain
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Cardiology Department, Interventional Cardiology Section, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
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Cardiology Department, Interventional Cardiology Section, Hospital Universitario de Salamanca, 37007 Salamanca, Spain
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Cardiology Department, Interventional Cardiology Section, Hospital La Paz, 28046 Madrid, Spain
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Cardiology Department, Interventional Cardiology Section, Hospital Álvaro Cunqueiro, 36213 Vigo, Pontevedra, Spain
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Cardiology Department, Interventional Cardiology Section, Hospital La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid, 28006 Madrid, Spain
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Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(7), 2295; https://doi.org/10.3390/jcm9072295
Received: 13 June 2020 / Revised: 7 July 2020 / Accepted: 13 July 2020 / Published: 19 July 2020
(This article belongs to the Special Issue New Perspective in Atrial Fibrillation)
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. View Full-Text
Keywords: atrial fibrillation; bleeding risk; age; left atrial appendage closure atrial fibrillation; bleeding risk; age; left atrial appendage closure
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MDPI and ACS Style

López-Mínguez, J.R.; Nogales-Asensio, J.M.; Infante De Oliveira, E.; Santos, L.; Ruiz-Salmerón, R.; Arzamendi-Aizpurua, D.; Costa, M.; Gutiérrez-García, H.; Fernández-Díaz, J.A.; Freixa, X.; Cruz-González, I.; Moreno, R.; Íñiguez-Romo, A.; Alfonso-Manterola, F. Major Bleeding Predictors in Patients with Left Atrial Appendage Closure: The Iberian Registry II. J. Clin. Med. 2020, 9, 2295. https://doi.org/10.3390/jcm9072295

AMA Style

López-Mínguez JR, Nogales-Asensio JM, Infante De Oliveira E, Santos L, Ruiz-Salmerón R, Arzamendi-Aizpurua D, Costa M, Gutiérrez-García H, Fernández-Díaz JA, Freixa X, Cruz-González I, Moreno R, Íñiguez-Romo A, Alfonso-Manterola F. Major Bleeding Predictors in Patients with Left Atrial Appendage Closure: The Iberian Registry II. Journal of Clinical Medicine. 2020; 9(7):2295. https://doi.org/10.3390/jcm9072295

Chicago/Turabian Style

López-Mínguez, José R., Juan M. Nogales-Asensio, Eduardo Infante De Oliveira, Lino Santos, Rafael Ruiz-Salmerón, Dabit Arzamendi-Aizpurua, Marco Costa, Hipólito Gutiérrez-García, Jose A. Fernández-Díaz, Xavier Freixa, Ignacio Cruz-González, Raúl Moreno, Andrés Íñiguez-Romo, and Fernando Alfonso-Manterola. 2020. "Major Bleeding Predictors in Patients with Left Atrial Appendage Closure: The Iberian Registry II" Journal of Clinical Medicine 9, no. 7: 2295. https://doi.org/10.3390/jcm9072295

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