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. 2022 Jun;64(1):95-102.
doi: 10.1007/s10840-021-01090-z. Epub 2021 Nov 25.

Left atrial appendage occlusion in haemophilia patients with atrial fibrillation

Anders Dahl Kramer  1 , Kasper Korsholm  2 , Andreas Kristensen  2   3 , Lone Hvitfeldt Poulsen  4 , Jens Erik Nielsen-Kudsk  2
Affiliations

Left atrial appendage occlusion in haemophilia patients with atrial fibrillation

Anders Dahl Kramer et al. J Interv Card Electrophysiol. 2022 Jun.

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.

Keywords: Atrial fibrillation; Factor replacement therapy; Haemophilia; Left atrial appendage occlusion.

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