Left Atrial Appendage Occlusion in High Bleeding Risk Patients

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Atrial fibrillation (AF) poses a significant stroke risk, particularly in patients with high bleeding risk or contraindications to oral anticoagulation.
• Left atrial appendage occlusion (LAAO) offers an alternative stroke prevention strategy for these challenging patient populations.

Purpose of the Study:

• To evaluate the safety and efficacy of LAAO in patients with nonvalvular AF and high bleeding risk.
• To analyze the optimal antithrombotic therapy strategies following LAAO in this cohort.

Main Methods:

• A monocentric study included 68 patients with nonvalvular AF and high bleeding risk or contraindication to oral anticoagulant therapy.
• Patients underwent LAAO, with follow-up assessments at 3, 6, and 12 months, and a longer-term clinical follow-up of 1.4 ± 0.9 years.
• Antithrombotic strategies post-procedure included dual antiplatelet therapy, single antiplatelet therapy, or no antithrombotic therapy.

Main Results:

• Successful LAAO was achieved in 67 out of 68 patients.
• At discharge, most patients received either dual antiplatelet therapy (47%), single antiplatelet therapy or no antithrombotic (50%), or anticoagulant therapy (3%).
• During follow-up, late adverse events were infrequent (3/62 patients), including device-related thrombus (2) and extracranial bleeding (1). Device-related thrombosis was not linked to antithrombotic regimen.

Conclusions:

• LAAO is a feasible and safe procedure for stroke prevention in AF patients unsuitable for oral anticoagulation.
• Single antiplatelet therapy appears to be a safe and effective alternative to dual antiplatelet therapy post-LAAO, especially in high bleeding risk individuals.
• Dual antiplatelet therapy did not demonstrate additional benefit in this study population.