Renou Pauline, Thambo Jean-Benoît, Iriart Xavier, Nicot Stéphanie, Kabore Nathanael, Jalal Zakaria, Olindo Stéphane, Debruxelles Sabrina, Poli Mathilde, Rouanet François, Sibon Igor
Department of Neurology, CHU de Bordeaux, Bordeaux, France.
Inserm U-1045, LIRYC, Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, Bordeaux, France; Department of Congenital Cardiopathies, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France.
J Stroke Cerebrovasc Dis. 2017 Mar;26(3):545-551. doi: 10.1016/j.jstrokecerebrovasdis.2016.11.126. Epub 2016 Dec 30.
Percutaneous left atrial appendage closure (LAAC) may be considered in patients with atrial fibrillation and contraindication for long-term anticoagulation. This study aimed to assess the safety and efficacy of LAAC followed by single antiplatelet therapy in patients with atrial fibrillation and previous spontaneous intracerebral hemorrhage (ICH).
In this explorative, prospective, single-center study, consecutive patients who underwent LAAC because of previous spontaneous ICH over a period of 4 years were analyzed. Risks of ischemic strokes and hemorrhagic complications were estimated using the CHA2DS2-VASc and HAS-BLED scores, respectively. Single antiplatelet therapy was given for at least 6 months post implantation. Clinical follow-up included cardiological evaluations at 1, 3, 6, and 12 months, and neurological evaluations at 3 and 12 months.
A total of 46 patients underwent LAAC with a mean follow-up of 12 ± 7 months. The observed annual rate of ischemic stroke was 4.35% compared with an expected rate of 7.23% according to the mean risk of the population based on CHA2DS2-VASc score, which translated into a 40% risk reduction. The observed annual rate of major bleeding was 4.35% compared with an expected rate of 8.05% according to the mean risk of the population based on HAS-BLED score, which translated into a 46% risk reduction.
LAAC followed by single antiplatelet therapy is feasible as an alternative to oral anticoagulation in high-risk patients with previous ICH, with an acceptable periprocedural risk. Longer follow-up in a larger number of patients will be needed to establish the effectiveness of LAAC relative to direct oral anticoagulants.
对于房颤且有长期抗凝治疗禁忌证的患者，可考虑行经皮左心耳封堵术（LAAC）。本研究旨在评估房颤合并既往自发性脑出血（ICH）患者LAAC术后接受单一抗血小板治疗的安全性和有效性。
在这项探索性、前瞻性、单中心研究中，分析了4年内因既往自发性ICH而接受LAAC的连续患者。分别使用CHA2DS2-VASc和HAS-BLED评分评估缺血性卒中风险和出血并发症风险。植入后至少给予6个月的单一抗血小板治疗。临床随访包括在1、3、6和12个月时进行心脏评估，以及在3和12个月时进行神经学评估。
共有46例患者接受了LAAC，平均随访时间为12±7个月。根据基于CHA2DS2-VASc评分的人群平均风险，观察到的缺血性卒中年发生率为4.35%，而预期发生率为7.23%，这意味着风险降低了40%。根据基于HAS-BLED评分的人群平均风险，观察到的大出血年发生率为4.35%，而预期发生率为8.05%，这意味着风险降低了46%。
对于既往有ICH的高危患者，LAAC术后接受单一抗血小板治疗作为口服抗凝治疗的替代方案是可行的，围手术期风险可接受。需要对更多患者进行更长时间的随访，以确定LAAC相对于直接口服抗凝剂的有效性。
