Sanz Segura Patricia, Jimeno Sánchez Javier, Arbonés-Mainar José Miguel, Sánchez-Rubio Lezcano Juan, Galache Osuna Gabriel, Bernal Monterde Vanesa
Gastroenterology Department, Royo Villanova Hospital, Zaragoza, Spain.
Interventional Cardiology Unit, Miguel Servet University Hospital, Zaragoza, Spain.
Scand J Gastroenterol. 2023 Jul-Dec;58(12):1547-1554. doi: 10.1080/00365521.2023.2239973. Epub 2023 Jul 25.
Percutaneous left atrial appendage closure (LAAC) has shown non-inferiority compared to oral anticoagulation (OAC) in preventing atrial fibrillation (AF)-related stroke. The objective of this study was to assess whether LAAC reduces the incidence of gastrointestinal bleeding (GIB) and/or chronic anaemia associated with OAC, as well as the consumption of healthcare resources.
Prospective, single-center study from 2016 to 2022, LAAC was performed. Clinical, analytical and healthcare resource consumption data were collected (endoscopies, blood transfusions, hospital admissions) prior and 6 months after LAAC.
43 patients were included, with an average age of 77.6 years. LAAC indication was upper, low and obscure GIB in 7 (16%), 8 (19%) and 28 patients (65%) respectively. GIB source was intestinal angiodysplasias in 27 patients (63%), occult origin in 12 (28%), and others (antral vascular ectasia, portal hypertension gastropathy, etc.) in 4 patients (9%). The mean number of packed red blood cells per patient before LAAC was (mean ± SD) 7.29 ± 5 vs 0.42 ± 1.3 ( < 0.001); endoscopic procedures were 4.34 ± 2.85 vs 0.27 ± 0.76 ( < 0.001); and hospitalizations 2.67 ± 2.14 vs 0.03 ± 0.17 ( < 0.001), with a hospital stay of 21.5 ± 17.3 vs 0.09 ± 0.5 days ( < 0.001) at 6 months post-intervention. Haemoglobin value increased from 8.1 ± 1.2g/dl to 12.4 ± 2.2g/dl ( < 0.001) at 6 months. No thromboembolic events were registered during a median follow-up of 16.6 months (range 6-65).
LAAC could be a safe and effective alternative to OAC in patients with non-valvular AF presenting significant, recurrent or potentially unresolvable GIB. This intervention also leads to important savings in the consumption of healthcare resources.
经皮左心耳封堵术（LAAC）在预防心房颤动（AF）相关卒中方面已显示出不劣于口服抗凝药（OAC）。本研究的目的是评估LAAC是否能降低与OAC相关的胃肠道出血（GIB）和/或慢性贫血的发生率，以及医疗资源的消耗。
这是一项2016年至2022年的前瞻性单中心研究，实施了LAAC。收集了LAAC术前及术后6个月的临床、分析和医疗资源消耗数据（内镜检查、输血、住院情况）。
纳入43例患者，平均年龄77.6岁。LAAC的适应症分别为7例（16%）、8例（19%）和28例（65%）的上消化道、下消化道和不明原因的GIB。GIB的来源为27例（63%）的肠道血管发育异常、12例（28%）的隐匿性来源以及4例（9%）的其他情况（胃窦血管扩张、门静脉高压性胃病等）。LAAC术前每位患者的平均红细胞压积数量为（均值±标准差）7.29±5，术后为0.42±1.3（P<0.001）；内镜检查次数为4.34±2.85，术后为0.27±0.76（P<0.001）；住院次数为2.67±2.14，术后为0.03±0.17（P<0.001），干预后6个月的住院天数为21.5±17.3天，术后为0.09±0.5天（P<0.001）。术后6个月血红蛋白值从8.1±1.2g/dl升至12.4±2.2g/dl（P<0.001）。在中位随访16.6个月（范围6 - 65个月）期间未发生血栓栓塞事件。
对于出现严重、复发性或潜在无法解决的GIB的非瓣膜性AF患者，LAAC可能是一种安全有效的替代OAC的方法。这种干预还能显著节省医疗资源的消耗。
