According to a case study and literature review published in Thrombosis Research, left atrial appendage occlusion is safe and can be a successful strategy to reduce the long-term thromboembolic risk in patients with concurrent hemophilia and atrial fibrillation.
With the life expectancy of patients with hemophilia increasing due to improvements in standard of care reaching that of people without the disease, there is a growing population of elderly hemophilia patients. As a result, an increasing number of patients with hemophilia suffer from cardiovascular diseases such as atrial fibrillation. However, the treatment of this disease is complex in patients with hemophilia because antithrombotic therapy, the standard of care for atrial fibrillation, is contraindicated in this group of patients.
Here, Ming Y. Lim, MBBCh, MS, and Mouhamed Yazan Abou-Ismail, MD, from the Division of Hematology and Hematologic Malignancies at the Department of Internal Medicine, University of Utah in Salt Lake City describe the case of a 79-year-old patient with mild hemophilia A and atrial fibrillation who was successfully treated with left atrial appendage occlusion, an alternative that is used to prevent stroke in atrial fibrillation patients with a contraindication to antithrombotic therapy.
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The researchers also reviewed the literature for existing cases and concluded that left atrial appendage occlusion is safe in hemophilia patients with atrial fibrillation with appropriate hemostatic management.
Based on the findings of a single-center study of 5 patients with hemophilia, the researchers stated, “Other alternatives for stroke prevention in persons with hemophilia and [atrial fibrillation] include the use of low-dose direct oral anticoagulant.” They added, “However more clinical data is needed.”
Left atrial appendage occlusion is a one-off procedure to seal the left atrial appendage. It can reduce the risk of blood clot formation, thus reducing the risk of stroke, and eliminates the need to take blood-thinning medications for patients with atrial fibrillation.
Lim MY, Abou-Ismail MY. Left atrial appendage occlusion for management of atrial fibrillation in persons with hemophilia. Thromb Res. Published online August 5, 2021. doi:10.1016/j.thromres.2021.08.001