'Striking' Difference in Adverse Events in Women With Watchm
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Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation for select patients with atrial fibrillation; however, women have been underrepresented in clinical trials of LAAO, and sex-specific sub analyses are limited.

This study aimed to evaluate the sex differences in the baseline characteristics of patients undergoing LAAO implant and in the in-hospital outcomes after LAAO implant.

A total of 49 357 patients in the National Cardiovascular Data Registry LAAO Registry undergoing LAAO with the Watchman device were included in this study.

The primary outcomes were aborted or canceled procedure, major adverse event, any adverse event, prolonged hospital stay longer than 1 day, and death. Unadjusted and multivariable adjusted logistic regression analyses were performed to assess sex differences in in-hospital adverse events.

Results:
-- In this cohort study of 49 357 patients (mean age, 76.1 years), 20 388 women (41.3%) and 28 969 (58.7%) men underwent LAAO.

-- Compared with men, women were older and had a higher prevalence of paroxysmal atrial fibrillation, prior stroke, and uncontrolled hypertension but a lower prevalence of congestive heart failure, diabetes, and coronary artery disease.

-- After multivariable adjustment, there were no differences in aborted or canceled procedures between women and men (613 vs 851).

-- Women were more likely than men to experience any adverse event (1284 vs 1144) or major adverse event (827 vs 567) owing to pericardial effusion requiring drainage (241 vs 144) or major bleeding (349 vs 244).

-- Women were also more likely than men to experience a hospital stay longer than 1 day (3272 vs 3355) or death, although death was rare and absolute differences were minimal (58 vs 37).

Conclusively, this study suggests that, compared with men, women have a significantly higher risk of in-hospital adverse events after LAAO. Further research aimed at risk reduction, particularly strategies to reduce the risk of pericardial effusion and major bleeding, in women undergoing LAAO is warranted.

Source: https://jamanetwork.com/journals/jamacardiology/article-abstract/2782726
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