Dialyse aktuell 2021; 25(07): 273-278
DOI: 10.1055/a-1402-8764
Schwerpunkt
Nephrologie

Interventioneller Vorhofohrverschluss

Indikation bei chronisch nierenkranken Menschen
Boris Schmidt
1   Cardioangiologisches Centrum Bethanien, Medizinische Klinik 3 – Klinik für Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt a. M.
,
Kyrill Rogacev
2   Klinik für Kardiologie, Sana Hanse-Klinikum Wismar, Wismar
› Author Affiliations

ZUSAMMENFASSUNG

Bedauerlicherweise existieren bisher keine randomisierten Studiendaten hinsichtlich des Stellenwerts eines Vorhofohrverschlusssystems (LAAC: „left atrial appendage closure“) im Vergleich zu oralen Antikoagulanzien (OAK) bei CKD-Patienten (CKD: „chronic kidney disease“). Eine derartige Studie (WATCH AFIB in CKD) wurde wegen geringer Rekrutierungszahlen eingestellt. Aus den im Beitrag angesprochenen Beobachtungsstudien kann allerdings eine gute Sicherheit und Effektivität der Therapie abgeleitet werden. In Anbetracht der unzureichenden Evidenz sollte bei VHF Patienten (VHF: Vorhofflimmern) mit CKD bis zu einer glomerulären Filtrationsrate (GFR) von 30 ml/min/1,73 m2 primär eine NOAK-Therapie (NOAK: neue OAK) verordnet werden. Im Falle von Blutungen kann dann gemäß Leitlinienempfehlung eine LAAC alternativ angeboten werden. Im Falle von Patienten mit dialysepflichtiger CKD muss eine individuelle Entscheidung getroffen werden, ob und wie eine Thromboembolieprophylaxe durchgeführt werden soll.



Publication History

Article published online:
10 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Soliman EZ, Prineas RJ, Go AS. et al Chronic kidney disease and prevalent atrial fibrillation: The Chronic Renal Insufficiency Cohort (CRIC). Am Heart J 2010; 159: 1102-1107 DOI: 10.1016/j.ahj.2010.03.027.
  • 2 Ha JT, Neuen BL, Cheng LP. et al Benefits and harms of oral anticoagulant therapy in chronic kidney disease. Ann Intern Med 2019; 171: 181-189 DOI: 10.7326/M19-0087.
  • 3 Wizemann V, Tong L, Satayathum S. et al Atrial fibrillation in hemodialysis patients: Clinical features and associations with anticoagulant therapy. Kidney Int 2012; 77: 1098-1106 DOI: 10.1038/ki.2009.477.
  • 4 Zimmerman D, Sood MM, Rigatto C. et al Systematic review and meta-analysis of incidence, prevalence and outcomes of atrial fibrillation in patients on dialysis. Nephrol Dial Transplant 2012; 27: 3816-3822 DOI: 10.1093/ndt/gfs416.
  • 5 Hindricks G, Potpara T, Dagres N. et al 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42: 373-498 DOI: 10.1093/eurheartj/ehaa612.
  • 6 January CT, Wann LS, Calkins H. et al 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 2019; 140: e125-e151 DOI: 10.1161/CIR.0000000000000665.
  • 7 Turakhia MP, Blankestijn PJ, Carrero JJ. et al Chronic kidney disease and arrhythmias: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Eur Heart J; 2018; 39: 2314-2325 DOI: 10.1093/eurheartj/ehy060.
  • 8 Bonde AN, Lip GYH, Kamper AL. et al Net clinical benefit of antithrombotic therapy in patients with atrial fibrillation and chronic kidney disease: A nationwide observational cohort study. J Am Coll Cardiol 2014; 64: 2471-2482 DOI: 10.1016/j.jacc.2014.09.051.
  • 9 Molnar AO, Bota SE, Garg AX. et al The risk of major hemorrhage with CKD. J Am Soc Nephrol 2016; 27: 2825-2832 DOI: 10.1681/ASN.2015050535.
  • 10 Shah M, Avgil Tsadok M, Jackevicius CA. et al Warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis. Circulation 2014; 129: 1196-1203 DOI: 10.1161/CIRCULATIONAHA.113.004777.
  • 11 Reinecke H, Nabauer M, Gerth A. et al Morbidity and treatment in patients with atrial fibrillation and chronic kidney disease. Kidney Int 2015; 87: 200-209 DOI: 10.1038/ki.2014.195.
  • 12 Chan KE, Edelman ER, Wenger JB. et al Dabigatran and rivaroxaban use in atrial fibrillation patients on hemodialysis. Circulation 2015; 131: 972-979 DOI: 10.1161/CIRCULATIONAHA.114.014113.
  • 13 Siontis KC, Zhang X, Eckard A. et al Outcomes Associated With Apixaban Use in Patients With End-Stage Kidney Disease and Atrial Fibrillation in the United States. Circulation 2018; 138: 1519-1529 DOI: 10.1161/CIRCULATIONAHA.118.035418.
  • 14 Vriese AS de, Caluwé R, Pyfferoen L. et al Multicenter randomized controlled trial of Vitamin K antagonist replacement by rivaroxaban with or without vitamin K2 in hemodialysis patients with atrial fibrillation: The Valkyrie study. J Am Soc Nephrol 2020; 31: 186-196 DOI: 10.1681/ASN.2019060579.
  • 15 Boersma LVA, Schmidt B, Betts TR. et al Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry. Eur Heart J 2016; 37: 2465-2474 DOI: 10.1093/eurheartj/ehv730.
  • 16 Landmesser U, Tondo C, Camm J. et al Left atrial appendage occlusion with the AMPLATZER Amulet device: one-year follow-up from the prospective global Amulet observational registry. EuroIntervention 2018; 14: e590-e597 DOI: 10.4244/EIJ-D-18-00344.
  • 17 Gangireddy SR, Halperin JL, Fuster V. et al Percutaneous left atrial appendage closure for stroke prevention in patients with atrial fibrillation: an assessment of net clinical benefit. Eur Heart J 2012; 33: 2700-2708 DOI: 10.1093/eurheartj/ehs292.
  • 18 Luani B, Genz C, Herold J. et al Cerebrovascular events, bleeding complications and device related thrombi in atrial fibrillation patients with chronic kidney disease and left atrial appendage closure with the WATCHMANTM device. BMC Cardiovasc Disord 2019; 19: 112 DOI: 10.1186/s12872-019-1097-0.
  • 19 Fastner C, Brachmann J, Lewalter T. et al Left atrial appendage closure in patients with chronic kidney disease: results from the German multicentre LAARGE registry. Clin Res Cardiol 2021; 110: 12-20 DOI: 10.1007/s00392-020-01638-5.
  • 20 Kefer J, Tzikas A, Freixa X. et al Impact of chronic kidney disease on left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation. Int J Cardiol 2016; 207: 335-340 DOI: 10.1016/j.ijcard.2016.01.003.
  • 21 Nombela-Franco L, Rodés-Cabau J, Cruz-Gonzalez I. et al Incidence, Predictors, and Prognostic Value of Acute Kidney Injury Among Patients Undergoing Left Atrial Appendage Closure. JACC Cardiovasc Interv 2018; 11: 1074-1083 DOI: 10.1016/j.jcin.2018.03.022.
  • 22 Bordignon S, Bologna F, Chen S. et al Percutaneous left atrial appendage closure in the presence of thrombus: A feasibility report. J Cardiovasc Electrophysiol 2019; 30: 2858-2863 DOI: 10.1111/jce.14246.
  • 23 Nielsen-Kudsk JE, Berti S, De Backer O. et al Use of Intracardiac Compared With Transesophageal Echocardiography for Left Atrial Appendage Occlusion in the Amulet Observational Study. JACC Cardiovasc Interv 2019; 12: 1030-1039 DOI: 10.1016/j.jcin.2019.04.035.
  • 24 Osmancik P, Herman D, Neuzil P. et al Left Atrial Appendage Closure Versus Direct Oral Anticoagulants in High-Risk Patients With Atrial Fibrillation. J Am Coll Cardiol 2020; 75: 3122-3135 DOI: 10.1016/j.jacc.2020.04.067.