title: Left Atrial Appendage Closure in Patients with Atrial Fibrillation and Previous Intracerebral Hemorrhage.
abstract: BACKGROUND
  Percutaneous left atrial appendage closure (LAAC) may be considered in patients with atrial fibrillation and contraindication for long-term anticoagulation. This study aimed to assess the safety and efficacy of LAAC followed by single antiplatelet therapy in patients with atrial fibrillation and previous spontaneous intracerebral hemorrhage (ICH).
  
  
  METHODS
  In this explorative, prospective, single-center study, consecutive patients who underwent LAAC because of previous spontaneous ICH over a period of 4 years were analyzed. Risks of ischemic strokes and hemorrhagic complications were estimated using the CHA2DS2-VASc and HAS-BLED scores, respectively. Single antiplatelet therapy was given for at least 6 months post implantation. Clinical follow-up included cardiological evaluations at 1, 3, 6, and 12 months, and neurological evaluations at 3 and 12 months.
  
  
  RESULTS
  A total of 46 patients underwent LAAC with a mean follow-up of 12 ± 7 months. The observed annual rate of ischemic stroke was 4.35% compared with an expected rate of 7.23% according to the mean risk of the population based on CHA2DS2-VASc score, which translated into a 40% risk reduction. The observed annual rate of major bleeding was 4.35% compared with an expected rate of 8.05% according to the mean risk of the population based on HAS-BLED score, which translated into a 46% risk reduction.
  
  
  CONCLUSIONS
  LAAC followed by single antiplatelet therapy is feasible as an alternative to oral anticoagulation in high-risk patients with previous ICH, with an acceptable periprocedural risk. Longer follow-up in a larger number of patients will be needed to establish the effectiveness of LAAC relative to direct oral anticoagulants.
authors.affiliation: Department of Neurology, CHU de Bordeaux, Bordeaux, France. Electronic address: pauline.renou@chu-bordeaux.fr.
authors.forename: Pauline
authors.initials: P
authors.lastname: Renou
authors.affiliation: Inserm U-1045, LIRYC, Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, Bordeaux, France; Department of Congenital Cardiopathies, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France.
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Thambo
authors.affiliation: Department of Congenital Cardiopathies, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Iriart
authors.affiliation: Department of Neurology, CHU de Bordeaux, Bordeaux, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Nicot
authors.affiliation: Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Kabore
authors.affiliation: Department of Congenital Cardiopathies, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Jalal
authors.affiliation: Department of Neurology, CHU de Bordeaux, Bordeaux, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Olindo
authors.affiliation: Department of Neurology, CHU de Bordeaux, Bordeaux, France.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Debruxelles
authors.affiliation: Department of Neurology, CHU de Bordeaux, Bordeaux, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Poli
authors.affiliation: Department of Neurology, CHU de Bordeaux, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Rouanet
authors.affiliation: Department of Neurology, CHU de Bordeaux, Bordeaux, France; INCIA, UMR 5287, Université de Bordeaux, Bordeaux, France.
authors.forename: Igor
authors.initials: I
authors.lastname: Sibon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D020517:Atrial Appendage / Q000187:drug effects / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000473:pathology*; D016657:Cerebral Amyloid Angiopathy; D002543:Cerebral Hemorrhage / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents; D001241:Aspirin
keywords: Left atrial appendage closure; atrial fibrillation; cerebral amyloid angiopathy; intracerebral hemorrhage; stroke