JACC. Clinical electrophysiology · 2025
Outcomes of Left Atrial Appendage Occlusion in Patients With Prior Gastrointestinal Bleeds.
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Darden Douglas, Katapadi Aashish, Huang Chien Yu, Zimmerman Sarah, Lakkireddy Dhanunjaya, Kabra Rajesh, Pothineni Naga Venkata K, Gopinathannair Rakesh, Munir Muhammad Bilal, Freeman James V, Hsu Jonathan C
Аннотация
BACKGROUND: Left atrial appendage occlusion (LAAO) is increasingly used as a stroke prevention strategy in patients with atrial fibrillation who have contraindications to oral anticoagulation, including prior gastrointestinal bleeding (GIB). However, the clinical risks and benefits of LAAO may differ substantially depending on the specific indication for the procedure, and outcomes in patients with prior GIB remain incompletely understood.
OBJECTIVES: The aim of this study was to evaluate in-hospital and long-term outcomes of LAAO in patients with prior GIB.
METHODS: Using data from the National Cardiovascular Data Registry LAAO Registry, patients who underwent Watchman LAAO between January 2016 and December 2022 were analyzed. In-hospital and long-term adverse events, mortality, and postimplantation antithrombotic prescriptions were compared between patients with and those without prior GIB.
RESULTS: Prior GIB was common (33.7%) in patients undergoing Watchman LAAO. These patients were older, had more comorbidities, and often underwent Watchman 2.5 (31.4% vs 41.3%) vs Watchman FLX (68.6% vs 58.7%) implantation than their non-GIB counterparts. After adjustment, prior GIB was associated with higher rates of in-hospital major complications (OR: 1.18; 95% CI: 1.10-1.26). At 45 days, these patients had increased risks for GIB (HR: 4.36; 95% CI: 4.07-4.66) and major bleeding (HR: 2.94; 95% CI: 2.74-3.16). At 1-year follow-up, they remained at significantly higher risk for GIB (HR: 3.84; 95% CI: 3.65-4.03), major bleeding (HR: 2.82; 95% CI: 2.67-2.98), and death (HR: 1.10; 95% CI: 1.06-1.14). Stroke risk was no different between groups. Overall, those with GIB were more likely to receive conservative postprocedural antithrombotic regimens, including higher rates of no antithrombotic agents, warfarin only, and dual antiplatelet therapy.
CONCLUSIONS: Patients with prior GIB undergoing LAAO experienced higher in-hospital complications and long-term risks for GIB and major bleeding, with no differences in stroke risk. This underscores the need for improved postprocedural strategies to mitigate bleeding risks.
OBJECTIVES: The aim of this study was to evaluate in-hospital and long-term outcomes of LAAO in patients with prior GIB.
METHODS: Using data from the National Cardiovascular Data Registry LAAO Registry, patients who underwent Watchman LAAO between January 2016 and December 2022 were analyzed. In-hospital and long-term adverse events, mortality, and postimplantation antithrombotic prescriptions were compared between patients with and those without prior GIB.
RESULTS: Prior GIB was common (33.7%) in patients undergoing Watchman LAAO. These patients were older, had more comorbidities, and often underwent Watchman 2.5 (31.4% vs 41.3%) vs Watchman FLX (68.6% vs 58.7%) implantation than their non-GIB counterparts. After adjustment, prior GIB was associated with higher rates of in-hospital major complications (OR: 1.18; 95% CI: 1.10-1.26). At 45 days, these patients had increased risks for GIB (HR: 4.36; 95% CI: 4.07-4.66) and major bleeding (HR: 2.94; 95% CI: 2.74-3.16). At 1-year follow-up, they remained at significantly higher risk for GIB (HR: 3.84; 95% CI: 3.65-4.03), major bleeding (HR: 2.82; 95% CI: 2.67-2.98), and death (HR: 1.10; 95% CI: 1.06-1.14). Stroke risk was no different between groups. Overall, those with GIB were more likely to receive conservative postprocedural antithrombotic regimens, including higher rates of no antithrombotic agents, warfarin only, and dual antiplatelet therapy.
CONCLUSIONS: Patients with prior GIB undergoing LAAO experienced higher in-hospital complications and long-term risks for GIB and major bleeding, with no differences in stroke risk. This underscores the need for improved postprocedural strategies to mitigate bleeding risks.