1. NEW OAC OR LAAC IF A PATIENT BLEEDS ON OAC? PRO LAAC
Boris Schmidt, FHRS
Cardioangiologisches Centrum Bethanien (CCB)
Frankfurt am Main, Germany

2. DISCLOSURES Activity Company Advisory Board Boston Sci Abbott
Research Grant
Biosense Webster
CardioFocus
Medtronic
Lifetech
Speaker‘s Honoraria

3. IF PATIENT BLEEDS - PRO LAAC
OUTCOME AFTER BLEEDING – ORBIT AF
Steinberg BA et al. Am J Cardiol 2017;119:1590e1595)

4. IF PATIENT BLEEDS - PRO LAAC
MANAGEMENT AFTER BLEEDING – ORBIT AF
Steinberg BA et al. Am J Cardiol 2017;119:1590e1595)

5. IF PATIENT BLEEDS - PRO LAAC
IF A PATIENT BLEEDS ON VKA
HR 0.73; P=0.04
LAO 40°
Reddy V et al. J Am Coll Cardiol Dec 19;70(24):

6. GI BLEEDING –RESUMPTION OF OAC?
IF PATIENT BLEEDS - PRO LAAC
GI BLEEDING –RESUMPTION OF OAC?
Steffel J et al. European Heart Journal (2018) 39, 1330–1393

7. HX OF ULCER–RESUMPTION OF OAC?
IF PATIENT BLEEDS - PRO LAAC
HX OF ULCER–RESUMPTION OF OAC?
Lee SJ J et al. Am J Cardiol 2012

8. INTRACRANIAL BLEEDING –RESUMPTION OF OAC?
IF PATIENT BLEEDS - PRO LAAC
INTRACRANIAL BLEEDING –RESUMPTION OF OAC?
Annual re-ICH rate under OAC 5% Metananlysis….Neurology 2017;89:687–696.
Steffel J et al. European Heart Journal (2018) 39, 1330–1393

9. IF PATIENT BLEEDS - PRO LAAC
ESC RECOMMENDATION
Particularly for severe and life-threatening bleedings without a clear secondary or reversible/treatable cause the risks of re-initiating anticoagulation may outweigh the benefits. In such cases, implantation of a left atrial appendage (LAA) occluder (…)may be considered (…).
Steffel J et al. European Heart Journal (2018) 39, 1330–1393

10. IF PATIENT BLEEDS - PRO LAAC
GLOBAL AMULET REGISTRY n=1088
61 centres in
Europe, Australia, Israel, Chile and Hong Kong. 6/15-9/16
Landmesser U et al. EuroIntervention Sep 20;13(7):

11. IF PATIENT BLEEDS - PRO LAAC
MAJOR BLEEDING –LAAC ?
72% of patients with Hx of bleeding. Annual Bleeding rate 10.3%/yr _> no ICH !!
30% periprocedural bleeding
Landmesser U et al. EuroIntervention Sep 20;13(7):

12. IF PATIENT BLEEDS - PRO LAAC
NOVEL POST-IMPLANT STRATEGIES – 6 WKS DAPT
Device-related thrombosis was detected in 2/107 (1.9%) cases
In 5/256 (2.0%) patients on DAPT, DRT was detected (WATCHMAN and WATCHMAN FLX, n=3;
AMPLATZER Cardiac Plug and Amulet, n=2).
Weise FK et al. EuroIntervention 2018;13:e2138-e2146

13. IF PATIENT BLEEDS - PRO LAAC
CHANGES IN MEDICATION DURING FU
Device-related thrombosis was detected in 2/107 (1.9%) cases
In 5/256 (2.0%) patients on DAPT, DRT was detected (WATCHMAN and WATCHMAN FLX, n=3;
AMPLATZER Cardiac Plug and Amulet, n=2).
Boersma L et al. ESC 2018

14. IF PATIENT BLEEDS - PRO LAAC
RRR FOR VARIOUS SUBGROUPS -EWOLUTION
Device-related thrombosis was detected in 2/107 (1.9%) cases
In 5/256 (2.0%) patients on DAPT, DRT was detected (WATCHMAN and WATCHMAN FLX, n=3;
AMPLATZER Cardiac Plug and Amulet, n=2).
Boersma L et al. ESC 2018

15. IF PATIENT BLEEDS - PRO LAAC
COMPLIANCE - NOAC
% DISCONTINUED

16. IF PATIENT BLEEDS - PRO LAAC
COMPLIANCE - LAAC

17. IF PATIENT BLEEDS - PRO LAAC
CONCLUSION – IF PATIENT BLEEDS ON OAC
MARKS FOR HIGH RISK SITUATION
LAAC PREFERABLE OVER OAC UNLESS REVERSIBLE CAUSE
LOW-INTENSITY OR SHORT DURATION APT FEASIBLE
LAAC PROVIDES UNINTERRUPTED PROPHYLAXIS