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Long-term safety and efficacy of left atrial appendage occlusion in dialysis patients with atrial fibrillation: a multi-center, prospective, open label, observational study

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Peer-reviewed

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https://www.repository.cam.ac.uk/handle/1810/361831

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Article

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Authors

Genovesi, Simonetta  ORCID logo  https://orcid.org/0000-0002-4699-4149
Rebora, Paola  ORCID logo  https://orcid.org/0000-0003-0606-5852

Abstract

ABSTRACT

              Background
              The prevalence of atrial fibrillation (AF) in end stage kidney disease (ESKD) patients undergoing dialysis is high, however, the high risk of bleeding often hampers with a correct anticoagulation in ESKD patients with AF, despite high thromboembolic risk. Left atrial appendage (LAA) occlusion is a anticoagulation (OAT) for thromboembolism prevention in AF populations with high hemorrhagic risk.
           
           
              Methods and Results
              The purpose of the study was to evaluate the efficacy and safety of LAA occlusion in a cohort of dialysis patients undergoing the procedure (LAA occlusion cohort, n = 106), in comparison with two other ESKD cohorts, one taking warfarin (Warfarin cohort, n = 114) and the other without anticoagulation therapy (No-OAT cohort, n = 148). After a median follow-up of 4 years, a Cox regression model, adjusted for possible confounding factors, showed that the hazard ratios (HRs) of thromboembolic events in the LAA occlusion cohort were 0.19 (95%CI 0.04–0.96; p = 0.045) and 0.16 (95%CI 0.04–0.66; p = 0.011) as compared with Warfarin and No-OAT cohorts, respectively. The HR of bleeding in the LAA occlusion cohort was 0.37 (95%CI 0.16–0.83; p = 0.017) compared to Warfarin cohort, while there were no significant differences between the LAA occlusion and the No-OAT cohort (HR 0.51; 95%CI 0.23–1.12; p = 0.094). Adjusted Cox regression models showed lower mortality in patients undergoing LAA occlusion as compared with both the Warfarin cohort (HR 0.60; 95%CI 0.38–0.94; p = 0.027) and no-OAT cohort (HR 0.52; 95%CI 0.34–0.78; p = 0.002). Thromboembolic events in the LAA occlusion cohort were lower than expected according to the CHA2DS2VASc score (1.7 [95%CI 0.3–3.0] vs 6.7 events per 100 person/years, p < 0.001).
           
           
              Conclusion
              In ESKD patients with AF, LAA occlusion is safe and effective and is associated with reduced mortality compared with OAT or no therapy.

Description

Acknowledgements: We are grateful to Dr Jacopo Oreglia, Dr Mario Gaggiotti, Dr Federica Ettori, Dr Roberto Palumbo, Prof. Francesca Viazzi, Dr Marco Breschi, Dr Paolo Orselli, Dr GianMaria Iadarola, Dr Consuela Mazzucchelli, Dr Marco Contarini and Dr Stefano Bianchi for helping in the data collection. We thank the Ethics Committee of the Province of Monza and Brianza for approving the study (LAAO-DIA, 17032016).


Funder: Ministry of Health, Italy; DOI: https://doi.org/10.13039/501100003196

Keywords

32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, Cardiovascular, Hematology, Kidney Disease, Clinical Research, Heart Disease, Prevention, Cardiovascular, 3 Good Health and Well Being

Journal Title

Clinical Kidney Journal

Conference Name

Journal ISSN

2048-8505
2048-8513

Volume Title

16

Publisher

Oxford University Press (OUP)

Publisher DOI

https://doi.org/10.1093/ckj/sfad221

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Except where otherwised noted, this item's license is described as https://creativecommons.org/licenses/by-nc/4.0/

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