Branzoli Stefano, Marini Massimiliano, Catanzariti Domenico, Pravadelli Cecilia, Pannone Luigi, D'Onghia Giovanni, Fantinel Mauro, Guarracini Fabrizio, Franceschini Gaia, Zadro Mirco, Baroni Giulia, Casagrande Silvia, Ottaviani Donatella, Turco Renato, Nicolussi Paolaz Serena, Annicchiarico Luciano, Corsini Francesco, Rordorf Roberto, Krishnadath Kausilia, Ravelli Flavia, de Asmundis Carlo, La Meir Mark
Cardiac Surgery Unit, Santa Chiara Hospital, Largo Medaglie d'Oro, 38122 Trento, Italy.
Cardiac Surgery Department, Universitair Ziekenhuis, Av du Laerbeek 101, 1090 Brussel, Belgium.
J Cardiovasc Dev Dis. 2025 May 1;12(5):173. doi: 10.3390/jcdd12050173.
Gastrointestinal bleeding in patients with atrial fibrillation is an indication for left appendage occlusion. All endovascular devices mandate antithrombotic therapies: rebleeding risk remains an issue. To date, there are no reports on gastrointestinal rebleeding and stroke prevention by left appendage occlusion without any antithrombotic therapy in this category of patients.
A total of 129 patients (male 85, mean age 76.6 ± 7.1, CHADSVasc 3.8 ± 1.5, HASBLED 3.3 ± 1.0; upper GI bleeding 10%, lower GI bleeding 86%, obscure occult 4.6%, on NOACS full dose 77.5%, NOACs reduced dose 13.1%, on anti-vitamin K 9.3%) with atrial fibrillation and history of repetitive gastrointestinal bleeding from ten centers underwent standalone thoracoscopic epicardial appendage closure without antithrombotic therapy for the entire follow up.
The observed bleeding rate was 0.91 events per year, equivalent to a relative risk of RR = 0.17 ( = 0.02) and a relative risk reduction (RRR) of 83%. The observed relative risk of stroke was 0.91 events per year, with a relative risk of RR = 0.19 ( = 0.03) and a relative risk reduction (RRR) of 81%.
Standalone epicardial appendage occlusion without antithrombotic therapy in patients with repetitive gastrointestinal bleeding is safe and promising when rebleeding and stroke risk reduction need to be optimized.
心房颤动患者发生胃肠道出血是左心耳封堵的指征。所有血管内装置都需要抗血栓治疗：再出血风险仍然是一个问题。迄今为止，尚无关于此类患者在不进行任何抗血栓治疗的情况下通过左心耳封堵预防胃肠道再出血和中风的报道。
来自十个中心的129例心房颤动且有反复胃肠道出血病史的患者（男性85例，平均年龄76.6±7.1，CHADSVasc评分为3.8±1.5，HASBLED评分为3.3±1.0；上消化道出血10%，下消化道出血86%，隐匿性出血4.6%，接受全剂量新型口服抗凝药治疗的占77.5%，接受新型口服抗凝药减量治疗的占13.1%，接受维生素K拮抗剂治疗的占9.3%）在整个随访期间未接受抗血栓治疗，接受了独立的胸腔镜下心外膜心耳封堵术。
观察到的出血率为每年0.91次事件，相对风险RR = 0.17（P = 0.02），相对风险降低率（RRR）为83%。观察到的中风相对风险为每年0.91次事件，相对风险RR = 0.19（P = 0.03），相对风险降低率（RRR）为81%。
对于有反复胃肠道出血的患者，在需要优化降低再出血和中风风险时，不进行抗血栓治疗的独立心外膜心耳封堵术是安全且有前景的。
