{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T00:02:57Z","timestamp":1768003377827,"version":"3.49.0"},"reference-count":20,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2020,7,19]],"date-time":"2020-07-19T00:00:00Z","timestamp":1595116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction and objective: Major bleeding events in patients undergoing left atrial appendage closure (LAAC) range from 2.2 to 10.3 per 100 patient-years in different series. This study aimed to clarify the bleeding predictive factors that could influence these differences. Methods: LAAC was performed in 598 patients from the Iberian Registry II (1093 patient-years; median, 75.4 years). We conducted a multivariate analysis to identify predictive risk factors for major bleeding events. The occurrence of thromboembolic and bleeding events was compared to rates expected from CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke history, vascular disease, sex) and HAS-BLED (hypertension, abnormal renal and liver function, stroke, bleeding, labile INR, elderly, drugs or alcohol) scores. Results: Cox regression analysis revealed that age \u226575 years (HR: 2.5; 95% CI: 1.3 to 4.8; p = 0.004) and a history of gastrointestinal bleeding (GIB) (HR: 2.1; 95% CI: 1.1 to 3.9; p = 0.020) were two factors independently associated with major bleeding during follow-up. Patients aged &lt;75 or \u226575 years had median CHA2DS2-VASc scores of 4 (IQR: 2) and 5 (IQR: 2), respectively (p &lt; 0.001) and HAS-BLED scores were 3 (IQR: 1) and 3 (IQR: 1) for each group (p = 0.007). Events presented as follow-up adjusted rates according to age groups were stroke (1.2% vs. 2.9%; HR: 2.4, p = 0.12) and major bleeding (3.7 vs. 9.0 per 100 patient-years; HR: 2.4, p = 0.002). Expected major bleedings according to HAS-BLED scores were 6.2% vs. 6.6%, respectively. In patients with GIB history, major bleeding events were 6.1% patient-years (HAS-BLED score was 3.8 \u00b1 1.1) compared to 2.7% patients-year in patients with no previous GIB history (HAS-BLED score was 3.4 \u00b1 1.2; p = 0.029). Conclusions: In this high-risk population, GIB history and age \u226575 years are the main predictors of major bleeding events after LAAC, especially during the first year. Age seems to have a greater influence on major bleeding events than on thromboembolic risk in these patients.<\/jats:p>","DOI":"10.3390\/jcm9072295","type":"journal-article","created":{"date-parts":[[2020,7,22]],"date-time":"2020-07-22T03:23:16Z","timestamp":1595388196000},"page":"2295","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Major Bleeding Predictors in Patients with Left Atrial Appendage Closure: The Iberian Registry II"],"prefix":"10.3390","volume":"9","author":[{"given":"Jos\u00e9 Ram\u00f3n","family":"L\u00f3pez-M\u00ednguez","sequence":"first","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital Universitario de Badajoz, 06080 Badajoz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Manuel","family":"Nogales-Asensio","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital Universitario de Badajoz, 06080 Badajoz, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Infante De Oliveira","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital de Santa Mar\u00eda, 1649-028 Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lino","family":"Santos","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Centro Hospitalario de Vila Nova de Gaia, 4430-999 Vila Nova de Gaia Oporto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rafael","family":"Ruiz-Salmer\u00f3n","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital Virgen de la Macarena, 41009 Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dabit","family":"Arzamendi-Aizpurua","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital Santa Creu i San Pau, 08041 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Costa","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Centro Hospitalar e Universit\u00e1rio de Coimbra, 3004-561 Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hip\u00f3lito","family":"Guti\u00e9rrez-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital Cl\u00ednico de Valladolid, 47003 Valladolid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose Antonio","family":"Fern\u00e1ndez-D\u00edaz","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital Puerta de Hierro, Majadahona, 28222 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3203-9060","authenticated-orcid":false,"given":"Xavier","family":"Freixa","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio","family":"Cruz-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital Universitario de Salamanca, 37007 Salamanca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ra\u00fal","family":"Moreno","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital La Paz, 28046 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9s","family":"\u00cd\u00f1iguez-Romo","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital \u00c1lvaro Cunqueiro, 36213 Vigo, Pontevedra, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Alfonso-Manterola","sequence":"additional","affiliation":[{"name":"Cardiology Department, Interventional Cardiology Section, Hospital La Princesa, IIS-IP, CIBER-CV, Universidad Aut\u00f3noma de Madrid, 28006 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2190","DOI":"10.1016\/j.jacc.2016.02.053","article-title":"Left Atrial Appendage Closure in Patients With Contraindications to Oral Anticoagulation","volume":"67","author":"Sharma","year":"2016","journal-title":"J. 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