Long term safety and efficacy of left atrial appendage occlusion in dialysis patients with atrial fibrillation: a multi-center, prospective, open label, observational study

Abstract The prevalence of atrial fibrillation (AF) in end stage kidney disease (ESKD) patients undergoing dialysis is high, however, the high risk bleeding often hampers with a correct anticoagulation ESKD AF, despite thromboembolic risk. Left appendage (LAA) occlusion possible alternative to oral (OAT) for thromboembolism prevention AF populations hemorrhagic purpose study was evaluate efficacy and safety LAA cohort procedure (LAA cohort, n = 106), comparison two other cohorts, one taking warfarin (Warfarin 114) without therapy (No-OAT 148). After median follow-up 4 years, Cox regression model, adjusted confounding factors, showed that hazard ratios (HRs) events were 0.19 (95%CI 0.04–0.96; p 0.045) 0.16 0.04–0.66; 0.011) as compared Warfarin No-OAT respectively. HR 0.37 0.16–0.83; 0.017) while there no significant differences between (HR 0.51; 95% 0.23–1.12; 0.094). Adjusted models lower mortality both 0.60; 95%CI 0.38–0.94; 0.027) no-OAT 0.52; 0.34–0.78; 0.002). Thromboembolic than expected according CHA2DS2VASc score (1.7 [95%CI 0.3–3.0] vs 6.7 per 100 person/years, < 0.001). In safe effective associated reduced OAT or therapy.