Abstract 627 Assessment of risk factors and outcome of device-related thrombosis in patients undergoing left atrial appendage occlusion – an analysis from the multicenter EUROC-DRT registry

Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Assessment of risk factors and outcome of device-related thrombosis in patients undergoing left atrial appendage occlusion – an analysis from the multicenter EUROC-DRT registry
V. O. Vij¹, B. Al-Kassou¹, S. Gloekler², R. Galea², M. Fürholz², B. Meier², M. Valgimigli², G. O'Hara³, D. Arzamendi⁴, V. Agudelo⁴, X. Freixa⁵, E. Flores-Umanzor⁵, O. De Backer⁶, L. Sondergaard⁶, L. Nombela-Franco⁷, A. McInerney⁷, K. Korsholm⁸, J.-E. Nielsen-Kudsk⁸, S. S. Afzal⁹, T. Zeus⁹, F. K. Operhalski¹⁰, B. Schmidt¹¹, G. Montalescot¹², P. Guedeney¹², X. Iriart¹³, M. Miton¹³, S. Saw¹⁴, T. Gilhofer¹⁵, L. Fauchier¹⁶, F. Meincke¹⁷, E. Veliqi¹⁷, N. Petri¹⁸, P. Nordbeck¹⁸, S. Rycerz¹⁹, D. Ognerubov²⁰, E. Merkulow²⁰, I. Cruz-Gonzalez²¹, R. González Ferreiro²¹, D. Bhatt²², A. Laricchia²³, A. Mangieri²³, H. Omran²⁴, J. W. Schrickel¹, J. Rodes-Cabau³, G. Nickenig¹, A. Sedaghat¹
¹Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; ²Inselspital - Universitätsspital Bern, Bern, CH; ³Quebec Heart & Lung Institute, Quebec City, Canada, CA; ⁴Hospital de la Santa Creu i Sant Pau, Barcelona, ES; ⁵Hospital Clinic Barcelona, Barcelona, ES; ⁶Rigshospitalet Copenhagen University Hospital, Copenhagen, DK; ⁷Hospital Clinico San Carlos, Madrid, ES; ⁸Aarhus University Hospital, Aarhus, DK; ⁹Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf; ¹⁰Medizinische Klinik I, Main-Kinzig-Kliniken GgmbH, Gelnhausen; ¹¹CCB im AGAPLESION MARKUS KRANKENHAUS, Frankfurt am Main; ¹²Surbonne University Pitié-Salpêtrière Hospital (AP-HP), Paris, FR; ¹³University Hospital Bordeaux, Bordeaux, FR; ¹⁴Vancouver General Hospital, Vancouver, CA; ¹⁵Kardiologie, Stadtspital Triemli Zürich, Zürich, CH; ¹⁶University Hospital Tours, Tours, FR; ¹⁷Kardiologie, Asklepios Klinik St. Georg, Hamburg; ¹⁸Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg; ¹⁹Klinik für Innere Medizin III: Kardiologie und Intensivmedizin, Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen; ²⁰Russian Cardiology Research and Production Complex, Moscow, RU; ²¹University Hospital of Salamanca, Salamanca, ES; ²²Harvard Medical School, Boston,, US; ²³Maria Cecilia Hospital Cotignola, Cotignola, IT; ²⁴Innere Medizin, St. Marien-Hospital, Bonn;
BACKGROUND Left atrial appendage closure (LAAc) is a feasible alternative in stroke prevention, however device-related thrombosis (DRT) is a common complication that is paradoxically linked to an increased rate of adverse events. As DRT are still not well understood, we assessed risk factors and outcome in this multicenter approach from the EUROC-DRT registry. METHODS AND RESULTS Overall, 825 patients (149 with and 676 without DRT) were compared in order to assess risk factors for DRT formation as well as impact on outcome. Parameters included medical history, baseline and postprocedural echocardiographic characteristics and anticoagulation regime. Patients with DRT formation were significantly older (76.2±8.5 vs. 74.5±9.1 years, p=0.029) and showed significantly higher incidences of prior stroke (54.4% vs. 36.0%, p<0.001) and non-paroxysmal atrial fibrillation (69.1% vs. 54.0%, p=0.001). Baseline echocardiography revealed a lower ejection fraction (52.8±10.6% vs. 54.6±11.8%, p=0.018) and left atrial appendage peak velocity (34.3±18.4 vs. 43.9±18.2 cm/s, p=0.001), as well as a higher incidence of spontaneous echocardiographic contrast (50.6% vs. 28.5%, p=0.001). Also, postprocedural dual antiplatelet therapy was less commonly initiated in patients with DRT (54.5% vs. 72.4%, p<0.001). Kaplan-Meier analysis revealed a significantly increased incidence of stroke after LAAc in patients with DRT, however no difference in mortality (figure 1&2). DISCUSSION DRT formation is a common complication after LAAc and is associated with an increased stroke risk. As several risk factors were identified, postprocedural echocardiographic follow-ups should be performed regularly, in order to prevent adverse events linked to DRT formation. For this matter, a further optimization of oral anticoagulation regimes is warranted.
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