Related Experiment Video
Updated: Mar 18, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Anticoagulation for Incident Atrial Fibrillation/Flutter Following Surgical Left Atrial Appendage Occlusion and CABG
Vivek Bhat1, Bharat Rawlley2, Kartik Gupta3
1Division of Cardiology, Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA.
Insights
Anticoagulation after surgical left atrial appendage occlusion (sLAAO) with coronary artery bypass grafting (CABG) did not reduce stroke or mortality risk in patients developing new atrial fibrillation/atrial flutter (AF/AFL). It significantly increased major bleeding risk.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Surgical left atrial appendage occlusion (sLAAO) is used to reduce stroke risk in atrial fibrillation (AF) patients.
- The prophylactic use of sLAAO with coronary artery bypass grafting (CABG) and the role of anticoagulation in patients developing new-onset AF/atrial flutter (AF/AFL) post-CABG-sLAAO are not well-defined.
Purpose of the Study:
- To compare outcomes of anticoagulation versus no anticoagulation in patients who developed new AF/AFL after undergoing CABG-sLAAO.
- To evaluate the risks of ischemic stroke, major bleeding, and all-cause mortality in this patient cohort.
Main Methods:
- A retrospective analysis using the TriNetX database identified patients with prior CABG-sLAAO who developed new AF/AFL.
- Patients were stratified into anticoagulation and no anticoagulation groups.
- Propensity score matching (PSM) was employed to balance baseline characteristics, followed by outcome assessment.
Main Results:
- After PSM, 451 pairs of patients were analyzed. No significant difference was observed in the risk of ischemic stroke (9.3% vs. 7.3%) or all-cause mortality (9.6% vs. 11.2%) between the groups.
- However, the anticoagulation group experienced a significantly higher risk of major bleeding (10.6% vs. 5.2%).
Conclusions:
- Anticoagulation in patients developing new AF/AFL post-CABG-sLAAO is not associated with reduced stroke or mortality.
- Anticoagulation significantly increases the risk of major bleeding in this specific patient population.
- Findings suggest limited incremental benefit of anticoagulation and underscore the need for prospective studies.
Introduction:
Surgical left atrial appendage occlusion (sLAAO) reduces stroke in patients with atrial fibrillation (AF), but its benefit in those without pre-existing AF, when performed prophylactically with cardiac surgery, remains unclear. Further, the role of anticoagulation in patients who develop new AF or atrial flutter (AF/AFL) after sLAAO is not well defined. Given that new-onset AF commonly occurs after coronary artery bypass grafting (CABG), we aimed to compare outcomes between anticoagulation and no anticoagulation in patients developing new AF/AFL following CABG-sLAAO.
Methods:
Using TriNetX, we identified patients with prior CABG-sLAAO who subsequently developed new AF/AFL. Those with pre-existing AF/AFL and those who underwent percutaneous LAAO were excluded. Patients were categorized based on whether they received anticoagulation or not. Propensity score matching (PSM) was used to balance baseline characteristics, achieving a standardized mean difference of <0.1. Outcomes included ischemic stroke, major bleeding (per ISTH criteria), and all-cause mortality.
Results:
Out of 549 patients receiving anticoagulation and 1,004 not receiving anticoagulation, we identified 451 well-matched pairs. The mean age was 69 years, with >75% being male and >75% being White. Hypertension and type 2 diabetes were present in approximately 70% and 45% of the patients, respectively. Over 90% of the patients were on aspirin, beta-blockers, and lipid-lowering agents. There was no significant difference in risk of ischemic stroke (9.3% vs. 7.3%; risk ratio [RR] 1.27, 95% confidence interval [CI] 0.82-1.97, p = 0.28) or all-cause mortality (9.6% vs. 11.2%; RR 0.86, 95% CI 0.58-1.26, p = 0.43), but risk of major bleeding was higher with anticoagulation (10.6% vs. 5.2%; RR 2.04, 95% CI 1.15-3.62, p = 0.013).
Conclusions:
Among patients developing new AF/AFL after CABG-sLAAO, anticoagulation was not associated with lower risk of stroke or mortality but was linked to significantly greater bleeding risk. These findings suggest a limited incremental benefit of anticoagulation in this population and highlight the need for prospective evaluation.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:24Cardiac Catheterization III: Left Heart Catheterization