Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion
Background: Gastrointestinal bleeding in patients with atrial fibrillation is an indication for left appendage occlusion. All endovascular devices mandate antithrombotic therapies: rebleeding risk remains an issue. To date, there are no reports on gastrointestinal rebleeding and stroke prevention by...
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MDPI AG
2025-05-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| author | Stefano Branzoli Massimiliano Marini Domenico Catanzariti Cecilia Pravadelli Luigi Pannone Giovanni D’Onghia Mauro Fantinel Fabrizio Guarracini Gaia Franceschini Mirco Zadro Giulia Baroni Silvia Casagrande Donatella Ottaviani Renato Turco Serena Nicolussi Paolaz Luciano Annicchiarico Francesco Corsini Roberto Rordorf Kausilia Krishnadath Flavia Ravelli Carlo de Asmundis Mark La Meir |
| author_facet | Stefano Branzoli Massimiliano Marini Domenico Catanzariti Cecilia Pravadelli Luigi Pannone Giovanni D’Onghia Mauro Fantinel Fabrizio Guarracini Gaia Franceschini Mirco Zadro Giulia Baroni Silvia Casagrande Donatella Ottaviani Renato Turco Serena Nicolussi Paolaz Luciano Annicchiarico Francesco Corsini Roberto Rordorf Kausilia Krishnadath Flavia Ravelli Carlo de Asmundis Mark La Meir |
| author_sort | Stefano Branzoli |
| collection | DOAJ |
| description | Background: Gastrointestinal bleeding in patients with atrial fibrillation is an indication for left appendage occlusion. All endovascular devices mandate antithrombotic therapies: rebleeding risk remains an issue. To date, there are no reports on gastrointestinal rebleeding and stroke prevention by left appendage occlusion without any antithrombotic therapy in this category of patients. Methods: A total of 129 patients (male 85, mean age 76.6 ± 7.1, CHA<sub>2</sub>DS<sub>2</sub>Vasc 3.8 ± 1.5, HASBLED 3.3 ± 1.0; upper GI bleeding 10%, lower GI bleeding 86%, obscure occult 4.6%, on NOACS full dose 77.5%, NOACs reduced dose 13.1%, on anti-vitamin K 9.3%) with atrial fibrillation and history of repetitive gastrointestinal bleeding from ten centers underwent standalone thoracoscopic epicardial appendage closure without antithrombotic therapy for the entire follow up. Results: The observed bleeding rate was 0.91 events per year, equivalent to a relative risk of RR = 0.17 (<i>p</i> = 0.02) and a relative risk reduction (RRR) of 83%. The observed relative risk of stroke was 0.91 events per year, with a relative risk of RR = 0.19 (<i>p</i> = 0.03) and a relative risk reduction (RRR) of 81%. Conclusion: Standalone epicardial appendage occlusion without antithrombotic therapy in patients with repetitive gastrointestinal bleeding is safe and promising when rebleeding and stroke risk reduction need to be optimized. |
| format | Article |
| id | doaj-art-8439d3c9be164bb89598d2db995e1cfe |
| institution | OA Journals |
| issn | 2308-3425 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj-art-8439d3c9be164bb89598d2db995e1cfe2025-08-20T01:56:24ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252025-05-0112517310.3390/jcdd12050173Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage OcclusionStefano Branzoli0Massimiliano Marini1Domenico Catanzariti2Cecilia Pravadelli3Luigi Pannone4Giovanni D’Onghia5Mauro Fantinel6Fabrizio Guarracini7Gaia Franceschini8Mirco Zadro9Giulia Baroni10Silvia Casagrande11Donatella Ottaviani12Renato Turco13Serena Nicolussi Paolaz14Luciano Annicchiarico15Francesco Corsini16Roberto Rordorf17Kausilia Krishnadath18Flavia Ravelli19Carlo de Asmundis20Mark La Meir21Cardiac Surgery Unit, Santa Chiara Hospital, Largo Medaglie d’Oro, 38122 Trento, ItalyDepartment of Cardiology, Santa Chiara Hospital, Largo Medaglie d’Oro, 38122 Trento, ItalyDepartment of Cardiology, Santa Maria del Carmine Hospital, Corso Verona 4, 38068 Rovereto, ItalyDepartment of Gastroenterology, Santa Chiara Hospital, Largo Medaglie d’Oro, 38122 Trento, ItalyHeart Rhythm Management Center, Universitair Ziekenhuis, Av du Laerbeek 101, 1090 Brussel, BelgiumDepartment of Cardiology, Santa Chiara Hospital, Largo Medaglie d’Oro, 38122 Trento, ItalyDepartment of Cardiology, Santa Maria Hospital, Via Bagnols sur Ceze, 32032 Feltre, ItalyDepartment of Cardiology, Niguarda Hospital, Piazza Ospedale Maggiore, 20162 Milano, ItalyDepartment of Gastroenterology, Santa Chiara Hospital, Largo Medaglie d’Oro, 38122 Trento, ItalyCardiology Department, San Bassiano Hospital, Via Lotti, 36061 Bassano, ItalyCardiology Department, San Bassiano Hospital, Via Lotti, 36061 Bassano, ItalyNeurology Unit, Santa Maria del Carmine Hospital, Corso Verona, 38068 Rovereto, ItalyNeurology Unit, Santa Maria del Carmine Hospital, Corso Verona, 38068 Rovereto, ItalyGeriatrics Department, Santa Chiara Hospital, Largo Medaglie d’Oro, 38122 Trento, ItalyGeriatrics Department, Santa Maria del Carmine Hospital, Corso Verona, 38068 Rovereto, ItalyNeurosurgery Unit, Santa Chiara Hospital, Largo Medaglie d’Oro, 38122 Trento, ItalyNeurosurgery Unit, Santa Chiara Hospital, Largo Medaglie d’Oro, 38122 Trento, ItalyDepartment of Cardiology, IRCCS San Matteo, Via Golgi, 27100 Pavia, ItalyGastroneterology Department, Universitair Ziekenhuis Antwerpen, 2650 Antwerp, BelgiumLaboratory of Biophysic and Translation Cardiology, Department of Cellular Computational and Integrative Biology (CIBIO), Centre for Medical Sciences (CISMed), University of Trento, 38123 Trento, ItalyHeart Rhythm Management Center, Universitair Ziekenhuis, Av du Laerbeek 101, 1090 Brussel, BelgiumCardiac Surgery Unit, Santa Chiara Hospital, Largo Medaglie d’Oro, 38122 Trento, ItalyBackground: Gastrointestinal bleeding in patients with atrial fibrillation is an indication for left appendage occlusion. All endovascular devices mandate antithrombotic therapies: rebleeding risk remains an issue. To date, there are no reports on gastrointestinal rebleeding and stroke prevention by left appendage occlusion without any antithrombotic therapy in this category of patients. Methods: A total of 129 patients (male 85, mean age 76.6 ± 7.1, CHA<sub>2</sub>DS<sub>2</sub>Vasc 3.8 ± 1.5, HASBLED 3.3 ± 1.0; upper GI bleeding 10%, lower GI bleeding 86%, obscure occult 4.6%, on NOACS full dose 77.5%, NOACs reduced dose 13.1%, on anti-vitamin K 9.3%) with atrial fibrillation and history of repetitive gastrointestinal bleeding from ten centers underwent standalone thoracoscopic epicardial appendage closure without antithrombotic therapy for the entire follow up. Results: The observed bleeding rate was 0.91 events per year, equivalent to a relative risk of RR = 0.17 (<i>p</i> = 0.02) and a relative risk reduction (RRR) of 83%. The observed relative risk of stroke was 0.91 events per year, with a relative risk of RR = 0.19 (<i>p</i> = 0.03) and a relative risk reduction (RRR) of 81%. Conclusion: Standalone epicardial appendage occlusion without antithrombotic therapy in patients with repetitive gastrointestinal bleeding is safe and promising when rebleeding and stroke risk reduction need to be optimized.https://www.mdpi.com/2308-3425/12/5/173atrial fibrillationappendage occlusionthoracoscopygastrointestinal bleedinganticoagulantsantithrombotic therapy |
| spellingShingle | Stefano Branzoli Massimiliano Marini Domenico Catanzariti Cecilia Pravadelli Luigi Pannone Giovanni D’Onghia Mauro Fantinel Fabrizio Guarracini Gaia Franceschini Mirco Zadro Giulia Baroni Silvia Casagrande Donatella Ottaviani Renato Turco Serena Nicolussi Paolaz Luciano Annicchiarico Francesco Corsini Roberto Rordorf Kausilia Krishnadath Flavia Ravelli Carlo de Asmundis Mark La Meir Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion Journal of Cardiovascular Development and Disease atrial fibrillation appendage occlusion thoracoscopy gastrointestinal bleeding anticoagulants antithrombotic therapy |
| title | Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion |
| title_full | Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion |
| title_fullStr | Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion |
| title_full_unstemmed | Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion |
| title_short | Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion |
| title_sort | patients with gastrointestinal bleeding and atrial fibrillation potential ideal target for epicardial appendage occlusion |
| topic | atrial fibrillation appendage occlusion thoracoscopy gastrointestinal bleeding anticoagulants antithrombotic therapy |
| url | https://www.mdpi.com/2308-3425/12/5/173 |
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