Abstract
Purpose
Advanced targeted therapy has resulted in increasing life expectancy and incidence of age-related cardiovascular diseases like atrial fibrillation in patients with haemophilia. Oral anticoagulation constitutes a significant dilemma in this patient category as the risks of stroke and bleeding are difficult to balance. We sought to demonstrate the feasibility of left atrial appendage occlusion (LAAO) in patients with haemophilia and atrial fibrillation.
Methods
All patients with haemophilia treated with LAAO at Aarhus University Hospital, Denmark, were identified from a local prospective database comprising all consecutive LAAO procedures from 2010 up to November 2020. Based on review of the medical records, a retrospective descriptive analysis was performed.
Results
Seven patients with haemophilia A and atrial fibrillation underwent LAAO after multidisciplinary conference. Peri-procedural coagulation management was guided by factor VIII activity and treated with repeated bolus administrations of recombinant factor VIII targeting an activity of 100%. The implantation was successful in all patients with only minor bleeding complications post-procedurally. Based on these experiences, a suggested regime has been formulated.
Conclusions
LAAO is feasible in haemophilia patients with concurrent atrial fibrillation. However, special care including intravenous substitution with coagulation factors must be given in the periprocedural management.
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Data availability
Data supporting the findings of this study are available from the corresponding author upon reasonable request. However, due to data sensitivity, a full dataset will not be publicly available.
Code availability
Not applicable.
Abbreviations
- ACT:
-
Activated clotting time
- AF:
-
Atrial fibrillation
- CT:
-
Computed tomography
- DAPT:
-
Dual antiplatelet therapy
- DOAC:
-
Direct oral anticoagulation
- ICE:
-
Intracardiac echocardiography
- IU:
-
International units
- LAAO:
-
Left atrial appendage occlusion
- LMWH:
-
Low molecular weight heparin
- TEE:
-
Transoesophageal echocardiography
- TTE:
-
Transthoracic echocardiography
- TIA:
-
Transient ischemic attack
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Funding
ADK is currently enrolled as a PhD fellow at Aarhus University and has received a full scholarship from the institution. The project did not receive further funding.
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All the authors contributed to the study conception and design. Data collection and analysis was performed by ADK, KK, and AK. The first draft of the manuscript was written by ADK and all the authors critically revised several versions of the manuscript. Lastly, all the authors read and approved the final manuscript.
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Ethics approval
The study was approved by the Danish Patient Safety Authority (3–3013-2736/1) and Central Denmark Region (1–45-70–60-20) and carried out in accordance with the Declaration of Helsinki.
Consent to participate
All involved patients provided informed consent prior to intervention.
Conflict of interest
ADK has nothing to disclose. KK has received lecture fees from Abbott. AK has received advisory board fees and lecture fees from Bayer and AstraZeneca. LHP has been an investigator on clinical trials from Bayer Health Care and Novo Nordisk. JENK is a proctor for Abbott and Boston Scientific.
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Kramer, A.D., Korsholm, K., Kristensen, A. et al. Left atrial appendage occlusion in haemophilia patients with atrial fibrillation. J Interv Card Electrophysiol 64, 95–102 (2022). https://doi.org/10.1007/s10840-021-01090-z
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DOI: https://doi.org/10.1007/s10840-021-01090-z