PB0024 - LEFT ATRIAL APPENDAGE CLOSURE (LAAC) AS AN ALTERNATIVE TO ORAL ANTICOAGULATION (OACs) IN PATIENTS WITH ATRIAL FIBRILLATION (AF): A SINGLE CENTRE EXPERIENCE.

Background: LAAC is an alternative therapeutic option in patients with AF, who have contraindications or intolerance to OAC.

Aims: To describe the characteristics of patients proposed for LAAC in a Thrombosis and Haemostasis Unit of a third-level Centre, and analyse the hemorrhagic and ischemic events.

Methods: Observational study of 26 patients diagnosed with AF with contraindications to OAC, and proposed for LAAC. From January 2016 to December 2021, we collected clinical data about ischemic and bleeding events during the year before and the year after the date of procedure if performed, or proposed procedure if not performed. To evaluate clinical bleeding, we used ISTH-BAT (Bleeding Assessment Tools) score.

Results: Characteristics of both groups (n=26 patients) are summarized in Table1.Indications of LAAC were: bleeding history (65,4%)
(especially brain hemorrhage), labile international normalized ratio (INR) (23,1%), thrombocytopenia (7,7%), thrombocytopenia
and bleeding (3,9%). (Graphs 1). In patients group without procedure (n=10), only 1 patient suffered a subsequent episode of ischemic
stroke, and 2 deaths were reported. In patients with LAAC (n=16), no ischemic events were reported, but 1 patient died due to a new brain
hemorrhage. In patients who underwent LAAC, we found significant differences in pre-procedure and post-procedure ISTH-BAT (p=0.001 CI 1.2-4). However, no significant difference was found in mean ISTH-BAT prior to proposed closure and mean after, in patients in
whom it is not performed (95% CI 0.07-3.5).

Conclusion(s): In our experience, as in the literature, LAAC is a valid procedure in patients with AF and contraindicated OAC, especially beneficial in
cases of brain hemorrhage. The small sample size and application of a score not validated for these patients do not allow us to reach definitive
conclusions. Larger studies and validation of a hemorrhagic score that adequately weighs central nervous system (CNS) bleeding, would be
necessary.