PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE IN PATIENTS WITH HEMOSTASIS DISORDERS AND ANTICOAGULANT CONTRAINDICATION

BACKGROUND We report our single center experience with percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) and primary hemostasis disorders (HD). In randomized percutaneous LAAC trials, this HD population is under-represented. METHODS AND RESULTS Consecutive patients with primary HD who underwent LAAC were included. Baseline procedural characteristics and clinical events during follow-up were prospectively collected. From 2013 to 2021, 205 patients underwent percutaneous LAAC and 17 (8.2%) had proven HD: thrombocytopenia (n=5), myelodysplastic syndrome (n=6), Von Willebrand syndrome (n=4), type A hemophilia (n=1) and dysfibrinogenemia (n=1). Median age was 78 YO, CHA2DS2VASc and HAS-BLED scores were 5 and 3, respectively. Periprocedural plasmatic management was required in 47% of patients. The LAAC device implantation was successful in all cases. Post-procedural antithrombotic regimen for the first six weeks consisted of reduced direct oral anticoagulant (DOA) in 8 patients, full dose DOA in 1, dual-antiplatelet in 6, aspirin in 1 and no therapy in 1. The transesophageal echocardiography, 45 days post-procedure, showed optimal device position, adequate sealing in all patients and no clots. After this initial period post-LAAC the long-term antithrombotic regimen was single-antiplatelet in 16 patients and no therapy in 1 patient. After a median follow-up of 1.0 year (25-75 IQR: 0.4-2.2), no thrombo-embolic or bleeding events occurred. CONCLUSION The percutaneous LAAC in patients with atrial fibrillation and primary hemostasis disorders appeared to be a safe and effective alternative for stroke and bleeding prevention at mid-term follow-up. These promising results warrant larger studies to confirm our experience.