Anticoagulation Intensity during Appendage Occlusion: Lessons from Silent Cerebral Embolism.

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiology Pub Date : 2024-01-01 Epub Date: 2024-02-14 DOI:10.1159/000537708

Kexin Wang, Mingjia Xu, Zhe Wang, Zidun Wang, Mingfang Li, Hailei Liu, Hongwu Chen, Weizhu Ju, Minglong Chen

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Abstract

Introduction: Endovascular left atrial appendage occlusion (LAAO) is associated with a high incidence of peri-procedure silent cerebral embolism (SCE), while the recommended activated clotting time (ACT) level by the expert consensus is lower than that in atrial fibrillation (AF) ablation. The aim of our study was to investigate whether raising the targeted ACT level during LAAO to the same level as AF ablation could decrease the incidence of SCE.

Methods: It was a prospective observational cohort study. Consecutive AF patients receiving LAAO between January 2021 and December 2022 were included and categorized into two groups based on the time of enrollment. Patients enrolled in 2021 (group 250) maintained a target ACT level of ≥250 s during LAAO procedure, while patients enrolled in 2022 (group 300) maintained the peri-procedure ACT ≥300 s. All patients underwent cerebral magnetic resonance imaging before and after the procedure.

Results: A total of 81 patients were included (38 in the group 250 and 43 in the group 300). After inverse probability of treatment weighting (IPTW), patients in the group 250 showed a significantly lower incidence of SCE than group 300 (IPTW p = 0.038). Only a stable high ACT pattern could decrease the risk of SCE. No significant differences were found between other ACT change patterns on the SCE incidence.

Conclusion: Raising the peri-procedure ACT level to a stable 300 s could decrease the risk of the SCE without increasing the major bleeding events.

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阑尾闭塞期间的抗凝强度：无声脑栓塞的启示。

导言：血管内左心房阑尾闭塞术（LAAO）与围术期无声脑栓塞（SCE）的高发生率相关，而专家共识推荐的活化凝血时间（ACT）水平低于房颤消融术。我们的研究旨在探讨将 LAAO 期间的目标 ACT 水平提高到与房颤消融相同的水平是否能降低 SCE 的发生率：这是一项前瞻性观察性队列研究。研究纳入了 2021 年 1 月至 2022 年 12 月间接受 LAAO 的连续房颤患者，并根据入组时间分为两组。所有患者在手术前后均接受了脑磁共振成像（MRI）检查：共纳入 81 名患者（250 组 38 人，300 组 43 人）。经过逆治疗概率加权（IPTW）后，250 组患者的 SCE 发生率明显低于 300 组（IPTW p = 0.038）。只有稳定的高 ACT 模式才能降低 SCE 风险。结论：结论：将术前 ACT 水平提高到稳定的 300 秒可降低 SCE 风险，同时不会增加大出血事件。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiology 医学-心血管系统

CiteScore

3.40

自引率

5.30%

发文量

审稿时长

1.5 months

期刊介绍： ''Cardiology'' features first reports on original clinical, preclinical and fundamental research as well as ''Novel Insights from Clinical Experience'' and topical comprehensive reviews in selected areas of cardiovascular disease. ''Editorial Comments'' provide a critical but positive evaluation of a recent article. Papers not only describe but offer critical appraisals of new developments in non-invasive and invasive diagnostic methods and in pharmacologic, nutritional and mechanical/surgical therapies. Readers are thus kept informed of current strategies in the prevention, recognition and treatment of heart disease. Special sections in a variety of subspecialty areas reinforce the journal''s value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons, clinical physiologists, pharmacologists and professionals in other areas of medicine interested in current activity in cardiovascular diseases.