Left atrial appendage closure after a hospital admission for gastrointestinal bleeding in patients anticoagulated for atrial fibrillation.
Abstract
Background
There are no "real world" data on the actual impact of percutaneous left atrial appendage closure (LAAC) programs in the management of thromboembolic prevention after a hospital admission for gastrointestinal bleeding (GIB) in anticoagulated patients with atrial fibrillation (AF). We evaluated the utilization, predictors, and clinical outcomes of LAAC following GIB-related hospitalizations.
Methods
The multicenter PERSEO registry retrospectively enrolled consecutive anticoagulated AF patients discharged alive after a GIB (2021-2022) across all public Andalusian hospitals with LAAC programs. Baseline features and clinical outcomes were compared between LAAC and medical management using multivariable logistic, and time-dependent Andersen-Gill and Cox regression models.
Results
Among 1041 patients (median age 82 years, 48.7% male), only 70 (6.7%) underwent LAAC, at a median of 5 months post-discharge. LAAC was independently associated with younger age, previous bleeding, angiodysplasia, lower diastolic blood pressure, aspirin or direct oral anticoagulant use at admission, and tertiary referral-center care. LAAC was associated with a lower hazard of recurrent composite events (stroke/transient ischemic attack, systemic embolism, major or clinically relevant non-major bleeding, or death -HR 0.57, 95% CI 0.37-0.89, p=0.013) and with a lower hazard of all-cause mortality (HR 0.40, 95% CI 0.22-0.72, p=0.002).
Conclusions
In real-world clinical practice, LAAC was infrequently used after hospitalization for GIB in anticoagulated patients with AF, being selectively reserved for specific clinical phenotypes. Nevertheless, this strategy was associated with a lower risk of adverse outcomes after adjusting for measured confounders. These findings should be interpreted cautiously given the observational design of the study.