Discontinuation of Antithrombotic Management Following Left Atrial Appendage Occlusion in High Bleeding Risk Patients
ABSTRACT
Background
Antithrombotic therapy is required after left atrial appendage occlusion (LAAO) whilst endothelialization of the device occurs. LAAO patients are usually at high bleeding risk and the optimal antithrombotic regimen post-implantation remains debated.
Aims
We aimed to study the efficacy of using maximum of 6-month antithrombotic treatment post-LAAO in high bleeding risk patients with atrial fibrillation.
Methods
Data from patients who had LAAO at our center between 2015 and 2024 were examined. Those who were discharged on a plan of 6 months antithrombotic therapy were included. Incidence of stroke, transient ischaemic attack (TIA), major bleeding or death during follow-up was measured.
Results
A total of 128 patients met the analysis criteria. One hundred and six (82.8%) patients had a previous major bleeding event with or without oral anticoagulation. Seventy-eight (60.9%) patients had a previous stroke. The median CHA2DS2-VASc and HAS-BLED scores were 4 and 3 respectively. Complete closure of the left atrial appendage was achieved in 116 (90.6%) patients with no peri-device flow. Follow-up was obtained for 484 patient-years (median follow-up time 3.6 years). Post-procedure, 126 (98.4%) patients had antiplatelet therapy only, for 6 months or less. Stroke or TIA occurred in 5.5% of patients (1.45 per 100 patient-years)—a 69% reduction compared to the predicted risk. 10.2% of patients suffered from major bleeding (2.69 per 100 patient-years). 36.7% (9.71 per 100 patient-years) of patients died.
Conclusion
Complete cessation of antithrombotic treatment 6 months after LAAO was associated with a low incidence of subsequent stroke or TIA in patients at high bleeding risk.
Conflicts of Interest
Dr. James Cockburn reports he is a proctor/advisory for Boston and Medtronic. Dr. Sandeep Arunothayaraj reports he is a proctor for Edwards Lifesciences. Prof David Hildick-Smith reports he is a proctor/advisory for Boston, Edwards Lifesciences, Medtronic and Abbott. The other authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
