Discontinuation of Antithrombotic Management Following Left Atrial Appendage Occlusion in High Bleeding Risk Patients

Area of Science:

• Cardiology
• Interventional Cardiology
• Thrombosis Research

Background:

• Antithrombotic therapy is crucial post-left atrial appendage occlusion (LAAO) for device endothelialization.
• Patients undergoing LAAO often have high bleeding risk, making optimal antithrombotic strategies a clinical challenge.

Purpose of the Study:

• To evaluate the efficacy of a maximum 6-month antithrombotic treatment duration in high bleeding risk atrial fibrillation patients post-LAAO.
• To assess the safety and effectiveness of abbreviated antithrombotic regimens in this patient cohort.

Main Methods:

• Retrospective analysis of 128 LAAO patients treated between 2015-2024.
• Patients received a maximum of 6 months of antithrombotic therapy post-procedure.
• Outcomes including stroke, transient ischemic attack (TIA), major bleeding, and death were monitored.

Main Results:

• The study included 128 patients, many with prior bleeding events (82.8%) or stroke (60.9%).
• High closure rates (90.6%) were achieved. Stroke/TIA incidence was 5.5% (1.45/100 patient-years), a significant reduction from predicted risk.
• Major bleeding occurred in 10.2% (2.69/100 patient-years), and mortality was 36.7% (9.71/100 patient-years).

Conclusions:

• Complete cessation of antithrombotic treatment at 6 months post-LAAO is associated with low rates of stroke and TIA.
• This strategy appears effective and safe for high bleeding risk patients undergoing LAAO.