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.

Details

Title
Long-term safety and efficacy of left atrial appendage occlusion in dialysis patients with atrial fibrillation: a multi-center, prospective, open label, observational study
Author
Genovesi, Simonetta 1   VIAFID ORCID Logo  ; Porcu, Luca 2 ; Rebora, Paola 1   VIAFID ORCID Logo  ; Slaviero, Giorgio 3 ; Casu, Gavino 4 ; Bertoli, Silvio 5 ; Airoldi, Flavio 6 ; Buskermolen, Monique 7 ; Gallieni, Maurizio 7   VIAFID ORCID Logo  ; Pieruzzi, Federico 1 ; Rovaris, Giovanni 8 ; Montoli, Alberto 9 ; Piccaluga, Emanuela 10 ; Molon, Giulio 11   VIAFID ORCID Logo  ; Alberici, Federico 12   VIAFID ORCID Logo  ; Adamo, Marianna 13   VIAFID ORCID Logo  ; Gaspardone, Achille 14 ; D'Angelo, Giuseppe 15 ; Merella, Pierluigi 4 ; Vezzoli, Giuseppe 3 ; Trezzi, Barbara 1 ; Mazzone, Patrizio 16 

1  School of Medicine and Surgery, University of Milano-Bicocca , Monza , Italy 
2  Cancer Research UK Cambridge Institute, University of Cambridge , Cambridge , UK 
3  Nephrology Unit, IRCCS Ospedale San Raffaele , Milano , Italy 
4  Cardiology Unit, Azienda Ospedaliera Universitaria di Sassari , Sassari , Italy 
5  Dialysis and Nephrology Unit-IRCCS-Multimedica , Sesto S.Giovanni , Italy 
6  Electrophysiology Unit-IRCCS-Multimedica , Sesto S.Giovanni , Italy 
7  Nephrology and Dialysis Unit, ASST Fatebenefratelli Sacco , Milano , Italy 
8  Interventional Electrophysiology Unit, San Gerardo Hospital , Monza , Italy 
9  Nephrology Unit, Niguarda Hospital , Milano , Italy 
10  Interventional Cardiology Unit, Niguarda Hospital , Milano , Italy 
11  Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital , Negrar , Italy 
12  Nephrology Unit, ASST degli Spedali Civili di Brescia , Brescia , Italy 
13  Cardiology Unit, ASST degli Spedali Civili di Brescia , Brescia , Italy 
14  Cardiology Unit, S.Eugenio Hospital , Roma , Italy 
15  Cardiac Pacing Unit, IRCCS Ospedale San Raffaele , Milano , Italy 
16  Cardiology 3, “A. De Gasperis” Cardio Center, ASST GOM Niguarda Ca' Granda , Milan , Italy 
Pages
2683-2692
Publication year
2023
Publication date
Dec 2023
Publisher
Oxford University Press
ISSN
20488505
e-ISSN
20488513
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/ckj/sfad221
ProQuest document ID
3167996435
Copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. This work is published under https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.