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Published on: February 26, 2013
Major Bleeding Predictors in Patients with Left Atrial Appendage Closure: The Iberian Registry II
José Ramón López-Mínguez1, Juan Manuel Nogales-Asensio1, Eduardo Infante De Oliveira2
1Cardiology Department, Interventional Cardiology Section, Hospital Universitario de Badajoz, 06080 Badajoz, Spain.
Insights
Older age (≥75 years) and a history of gastrointestinal bleeding significantly increase major bleeding risk after left atrial appendage closure (LAAC). These factors are crucial for predicting adverse events in high-risk patients undergoing LAAC.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Major bleeding is a significant complication following left atrial appendage closure (LAAC), with reported rates varying widely.
- Identifying predictive factors for bleeding is essential to improve patient outcomes and manage risks associated with LAAC procedures.
Purpose of the Study:
- To identify independent predictors of major bleeding events in patients undergoing LAAC.
- To compare observed bleeding and thromboembolic event rates with those predicted by CHA2DS2-VASc and HAS-BLED scores.
Main Methods:
- A multivariate analysis was performed on data from 598 patients in the Iberian Registry II (1093 patient-years).
- Risk factors for major bleeding events were identified using Cox regression.
- Event rates were compared to CHA2DS2-VASc and HAS-BLED scores.
Main Results:
- Age ≥75 years (HR: 2.5) and a history of gastrointestinal bleeding (GIB) (HR: 2.1) were independently associated with major bleeding.
- Patients ≥75 years had higher CHA2DS2-VASc scores and experienced significantly more major bleeding events (9.0 per 100 patient-years) compared to younger patients (3.7 per 100 patient-years).
- Patients with a GIB history had higher rates of major bleeding events (6.1% patient-years) compared to those without (2.7% patient-years).
Conclusions:
- In high-risk patients undergoing LAAC, a history of GIB and age ≥75 years are primary predictors of major bleeding, particularly within the first year.
- Age appears to be a stronger predictor of major bleeding than thromboembolic risk in this population.
- These findings highlight the need for careful risk stratification and monitoring in elderly patients and those with a history of GIB undergoing LAAC.
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.
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