Percutaneous Left Atrial Appendage Closure in Patients with Blood Dyscrasia and Contraindication to Chronic Anticoagulation

Objectives: We aimed to report a single center experience with percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) and blood dyscrasia (BD). Background: Although strong data supports the LAAC, patients with coagulopathy and BD were under-represented in randomized trials. Methods: Consecutive patients with BD who underwent LAAC were included. Baseline and procedural characteristics and follow-up outcomes were prospectively collected. Results: From 2013 to 2020, 180 patients underwent LAAC and 14 (7.8%) had proven BD: thrombocytopenia (n=5), myelodysplastic syndrome (n=5), Von Willebrand syndrome (n=2), type A hemophilia (n=1) and dysfibrinogenemia (n=1). Median age was 78 YO, CHA2DS2VASc and HAS-BLED scores were respectively 4 and 3. Periprocedural plasmatic management was required in 50% of the patients. The WATCHMANTM, AMPLATZER CARDIAC PLUGTM and CARDIA ULTRASTEALTM devices were used in 12, 1 and 1 patients, respectively, and the procedure was successful in all cases. Post-procedural antithrombotic regimen for the first six weeks consisted of reduced direct anticoagulant (DOA) in 7 patients, dual-antiplatelet in 5, aspirin in 1 and no therapy in 1. Following that period, single-antiplatelet was used in 13 patients and no therapy in 1 patient. A transesophageal echocardiography 45 days post-procedure showed optimal device position and sealing in all patients. After a median follow-up of 1.4 years, no thrombo-embolic or bleeding events occurred. Conclusion: LAAC in patients with BD appeared to be a safe and effective alternative for stroke and bleeding prevention at mid-term follow-up. These promising results warrants larger studies to confirm our findings.