Risk of Gastrointestinal Bleeding in Patients Who Have Undergone Left Atrial Appendage Closure

Area of Science:

• Cardiology
• Gastroenterology
• Medical Devices

Background:

• Anticoagulation is standard for stroke prevention in atrial fibrillation (AF) patients at risk of gastrointestinal (GI) bleeding.
• Left atrial appendage closure (LAAC) using the Watchman device offers an alternative for patients with high thromboembolic or bleeding risks.

Purpose of the Study:

• To investigate the incidence of GI bleeding in patients with nonvalvular AF after LAAC.
• To identify predictors of GI bleeding post-Watchman device implantation.

Main Methods:

• Retrospective cohort study of 92 patients with nonvalvular AF undergoing LAAC.
• Follow-up period of 3 years to assess GI bleeding events.
• Cause-specific Cox proportional hazards models used to analyze bleeding and mortality risks.

Main Results:

• 11 bleeding events (12%) and 9 deaths (10%) were observed within 3 years.
• Increased CHA2DS2-VASc and HAS-BLED scores were independent predictors of GI bleeding.
• Prior GI bleeds increased bleeding hazard by 60% when controlling for CHA2DS2-VASc score.

Conclusions:

• Patients with Watchman devices remain at risk for GI bleeding post-implantation.
• Higher CHA2DS2-VASc and HAS-BLED scores are significant independent predictors of GI bleeding after LAAC.