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

Anticoagulation is used for stroke prevention in patients with atrial fibrillation (AF) who carry a risk for gastrointestinal (GI) bleeding. Left atrial appendage closure (LAAC) with the Watchman device is an alternative for patients with increased thromboembolic risk, major bleeding, or fall risk. Our study aimed to examine the incidence of GI bleeding in patients with nonvalvular AF following LAAC.

A retrospective cohort study of patients with nonvalvular AF who underwent LAAC at our institution between November 2016 and June 2024 was conducted. The primary outcome was GI bleeding after LAAC over a follow-up period of 3 years. Cause-specific Cox proportional hazards models were used to examine bleeding and death separately within 3 years following the Watchman procedure.

Of 92 patients, 11 bleeding events (12%) and 9 deaths (10%) occurred. The average CHA2DS2-VASc and HAS-BLED scores were 4.3 and 3.7, respectively. Among multivariable cause-specific models, per 1-point increase in CHA2DS2-VASc or HAS-BLED score, the hazard increased by 70% (HR: 1.70, 95% CI: 1.21, 2.38, P = 0.002) and 164% (HR: 1.83, 95% CI: 1.80, 3.87, P < 0.001), respectively. While controlling for CHA2DS2-VASc score, prior GI bleeds significantly increased the hazard of bleeding by 60% (HR: 1.60, 95% CI: 1.05, 2.45, P = 0.025). Prior bleeding events were not significantly associated with GI bleeding while controlling for HAS-BLED scores.

Patients with Watchman devices are still at risk for GI bleeding after device implantation despite the significant reductions in overall risk. Higher CHA2DS2-VASc and HAS-BLED scores are independent predictors of an increased risk of GI bleeding after the Watchman procedure.