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Left atrial appendage occlusion in haemophilia patients with atrial fibrillation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

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.

Author information

Authors and Affiliations

  1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

    Anders Dahl Kramer, Kasper Korsholm, Andreas Kristensen & Jens Erik Nielsen-Kudsk

  2. Department of Cardiology, University Hospital of North Norway, Tromsø, Norway

    Andreas Kristensen

  3. Department of Haematology, Haemophilia Centre West, Aarhus University Hospital, Aarhus, Denmark

    Lone Hvitfeldt Poulsen

Authors
  1. Anders Dahl Kramer
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  2. Kasper Korsholm
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  3. Andreas Kristensen
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  4. Lone Hvitfeldt Poulsen
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  5. Jens Erik Nielsen-Kudsk
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Contributions

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.

Corresponding author

Correspondence to Anders Dahl Kramer.

Ethics declarations

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

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