title: Patients with intracranial bleeding and atrial fibrillation treated with left atrial appendage occlusion: Results from the Amplatzer Cardiac Plug registry.
abstract: BACKGROUND
  In patients with non-valvular atrial fibrillation (NVAF), intracranial bleeding (ICB) constitutes a very challenging situation in which the rate of both ischemic and hemorrhagic events is increased. In these patients, left atrial appendage occlusion (LAAO) might represent a very valid alternative.
  
  
  OBJECTIVE
  To investigate the procedural safety and long-term outcome of patients undergoing LAAO therapy due to previous ICB.
  
  
  METHODS
  Data from the Amplatzer Cardiac Plug multicenter registry on 1047 consecutive patients were analyzed. Patients with previous ICB as indication for LAAO were compared to patients with other indications.
  
  
  RESULTS
  A total of 198 patients (18.9%) with previous ICB were identified. The CHA2DS2-VASc score was similar (4.5±1.5 vs. 4.4±1.6, p=0.687) and the HAS-BLED score was higher in patients with previous ICB compared to those without (3.5±1.1 vs. 3.1±1.2, p<0.001). No significant differences in peri-procedural major adverse events were observed (2.5 vs 5.4%, p=0.1). Patients with previous ICB were more frequently on single acetylsalicylic acid therapy after LAAO (42.4% vs. 28.3%; p<0.001). With an average follow-up of 1.3years, the observed annual stroke/TIA rate (procedure and follow-up) for patients with previous ICB was 1.4% (75% relative risk reduction). The observed annual major bleeding rate (procedure and follow-up) for patients with previous ICB was 0.7% (89% relative risk reduction).
  
  
  CONCLUSIONS
  In patients with NVAF and previous ICB, LAAO seemed to be a safe procedure and was associated with a significant reduction in stroke/TIA and a remarkably low frequency of major bleeding during follow-up.
authors.affiliation: AHEPA University Hospital, Thessaloniki, Greece. Electronic address: aptzikas@yahoo.com.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tzikas
authors.affiliation: Hospital Clinic of University of Barcelona, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.affiliation: Hospital Clinic of University of Barcelona, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Llull
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Sameer
authors.initials: S
authors.lastname: Gafoor
authors.affiliation: University Hospital of Bern, Bern, Switzerland.
authors.forename: Samera
authors.initials: S
authors.lastname: Shakir
authors.affiliation: University Hospital of Bonn, Bonn, Germany.
authors.forename: Heyder
authors.initials: H
authors.lastname: Omran
authors.affiliation: AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Giannakoulas
authors.affiliation: Fondazione Toscana Gabriele Monasterio, Massa, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.affiliation: Ospedale Careggi di Firenze, Florence, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
authors.affiliation: St-Luc University Hospital, Brussels, Belgium.
authors.forename: Joelle
authors.initials: J
authors.lastname: Kefer
authors.affiliation: Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
authors.forename: Adel
authors.initials: A
authors.lastname: Aminian
authors.affiliation: University Hospital of Bern, Bern, Switzerland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.affiliation: University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.affiliation: Aarhus University Hospital, Skejby, Denmark.
authors.forename: Jens Erik
authors.initials: JE
authors.lastname: Nielsen-Kudsk
authors.affiliation: University Hospital of Salamanca, Salamanca, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cruz-Gonzalez
authors.affiliation: Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Prapa
authors.initials: P
authors.lastname: Kanagaratnam
authors.affiliation: University Hospital of Bern, Bern, Switzerland; University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Montreal Heart Institute, Montreal, Canada.
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.affiliation: Universitätsmedizin Göttingen, Göttingen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
authors.affiliation: Coburg Hospital, Coburg, Germany.
authors.forename: Jai-Wun
authors.initials: JW
authors.lastname: Park
authors.affiliation: University Hospital of Bern, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: Haralampos
authors.initials: H
authors.lastname: Karvounis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000639:trends*
keywords: Device; LAA closure; Prevention; Stroke