Left atrial appendage closure after a hospital admission for gastrointestinal bleeding in patients anticoagulated for atrial fibrillation.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Del Toro Esperón Carlos, Contreras Muñoz Alberto, Nevado Portero Jaime, Ruiz Ortiz Martín, Pérez Cabeza Alejandro Isidoro, Mesa Rubio Dolores, Barreiro Mesa Lucas, González Manzanares Rafael, Recio Mayoral Alejandro, Reina Moreno Alejandro, Torres Llergo Javier, Martínez Rodríguez Ana María, Jordán Martínez Laura, Arco Adamuz Ismael, Martínez Ballesta Aurora María, López Espinosa Víctor Manuel, Delgado Prieto José Luis, Fernández Ruz Leopoldo, Ruiz Duthil Ana Delia, Cánovas Galindo Cristina, Corpas Pérez Sara, Gheorge Livia, Urgiles Ortiz Mauricio, García García María Teresa, Aceituno Cubero Jesús, Soto Rojas Gregorio, Girela Pérez Beatriz, Ballesteros Pradas Sara, Pérez Ramirez Virginia, Valle Alberca Almudena, Pérez Córdoba Susana, Sánchez Fernández José Javier, Calvo Bernal Beatriz, Gómez Menchero Antonio Enrique, Lluch Requerey Carmen, Del Río Lechuga Ana, Serrano Silva Juan José
Аннотация
METHODS: The multicenter PERSEO registry retrospectively enrolled consecutive anticoagulated AF patients discharged alive after a GIB (2021-2022) across all public Andalusian hospitals with LAAC programs. Baseline features and clinical outcomes were compared between LAAC and medical management using multivariable logistic, and time-dependent Andersen-Gill and Cox regression models.
RESULTS: Among 1041 patients (median age 82 years, 48.7% male), only 70 (6.7%) underwent LAAC, at a median of 5 months post-discharge. LAAC was independently associated with younger age, previous bleeding, angiodysplasia, lower diastolic blood pressure, aspirin or direct oral anticoagulant use at admission, and tertiary referral-center care. LAAC was associated with a lower hazard of recurrent composite events (stroke/transient ischemic attack, systemic embolism, major or clinically relevant non-major bleeding, or death -HR 0.57, 95% CI 0.37-0.89, p=0.013) and with a lower hazard of all-cause mortality (HR 0.40, 95% CI 0.22-0.72, p=0.002).
CONCLUSIONS: In real-world clinical practice, LAAC was infrequently used after hospitalization for GIB in anticoagulated patients with AF, being selectively reserved for specific clinical phenotypes. Nevertheless, this strategy was associated with a lower risk of adverse outcomes after adjusting for measured confounders. These findings should be interpreted cautiously given the observational design of the study.