Real world data on left atrial appendage closure after severe gastrointestinal bleeding in anticoagulated patients with atrial fibrillation: frequency and associated factors.

Q: What are the key findings of this study?

Only 6.7% of anticoagulated AF patients surviving severe gastrointestinal bleeding received left atrial appendage closure, associated with younger age and prior bleeding.

Q: What does this research mean for the field?

In anticoagulated patients with atrial fibrillation who survived severe gastrointestinal bleeding, only 6.7% underwent left atrial appendage closure (LAAC), with younger age and prior bleeding events associated with this strategy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

A Contreras Munoz; M Ruiz Ortiz; B Girela Perez; L Barreiro Mesa; A Recio Mayoral; Carlos del Toro Esperón; A M Martinez Rodriguez; A M Martinez Ballesta; L Fernandez Ruz; C Canovas Galindo; V Perez Ramirez; S Perez Cordoba; B Calvo Bernal; C Lluch Requerey; J J Serrano Silva

doi:10.1093/eurheartj/ehaf784.540

November 1, 2025European Heart Journal

Real world data on left atrial appendage closure after severe gastrointestinal bleeding in anticoagulated patients with atrial fibrillation: frequency and associated factors.

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Key result

LAAC rates reach only 6.7% among anticoagulated AF patients surviving severe GI bleeding.

Why the study?

Real-world data were lacking on the impact of percutaneous left atrial appendage closure programs for embolic event prevention after severe gastrointestinal bleeding in anticoagulated patients with atrial fibrillation.

What is the frequency of LAAC and what factors are associated with its use in anticoagulated AF patients surviving a severe GIB?

Key Points

This study aims to explore the frequency of left atrial appendage closure (LAAC) in anticoagulated patients with atrial fibrillation who survived severe gastrointestinal bleeding.
Retrospective multicentre analysis of patients discharged after severe gastrointestinal bleeding from Andalusian hospitals.
Included patients with a history of anticoagulation for atrial fibrillation and eligibility for LAAC or direct anticoagulants.
Frequency of LAAC procedures and comparative analysis of baseline features between LAAC-treated and medically managed patients were performed.
Among 1403 patients with severe GIB, 1041 met the criteria for inclusion.
Only 70 patients (6.7%) underwent LAAC, with a median time of 5 months post-discharge.
LAAC was associated with factors such as younger age, prior bleeding events, and certain treatments at admission.

Structured PICO

What is the frequency of LAAC and what factors are associated with its use in anticoagulated AF patients surviving a severe GIB?

P

Population

1041 patients discharged alive after a severe gastrointestinal bleeding (GIB), previously anticoagulated for atrial fibrillation (AF), and eligible for either left atrial appendage closure (LAAC) or direct anticoagulant treatment. Median age 82 years, 48.7% male.

I

Intervention

Percutaneous left atrial appendage closure (LAAC)

C

Comparator

Medical management (direct anticoagulant treatment)

O

Outcome

Frequency of percutaneous LAAC strategy in the follow-up and comparative analysis of baseline features between LAAC and medically managed patients

In real-world practice, only 6.7% of anticoagulated AF patients surviving a severe GIB undergo LAAC, with selection driven by younger age, prior bleeding, and tertiary center care.

Implication

LAAC is rarely performed after severe GIB in anticoagulated AF; this observational finding leaves open optimal post-bleeding strategies and selection criteria.

Abstract

Background There are no "real world" data on the actual impact of percutaneous left atrial appendage closure (LAAC) programs in the management of embolic event prevention after a severe gastrointestinal bleeding (GIB) in anticoagulated patients with atrial fibrillation (AF). Purpose Our main objective was to investigate the frequency of LAAC in anticoagulated AF patients surviving a severe GIB and to describe the differential features of these patients versus those medically managed in Andalusia (South of Spain). Methods All consecutive patients discharged alive from January 1st, 2021 to December 31st, 2022, after a severe GIB or intracranial haemorrhage, who were previously anticoagulated for AF, in all public Andalusian hospitals with LAAC program, and who could be eligible either for LAAC or direct anticoagulant treatment were included in a retrospective, multicentre study. This analysis focuses in patients with GIB. The frequency of a percutaneous LAAC strategy in the follow-up was registered. A comparative analysis of baseline features between those patients treated with LAAC and those medically managed was performed. Results Among a reference population of 7119044 inhabitants in 15 hospitals, 1403 patients were included in the study, and 1041 had a GIB and conform this study sample. Median age was 82 years [p25-75, 76-87 years] with 48.7% male patients. A LAAC procedure was performed in 70 patients (6.7%) at a median time of 5 [2-10] months after discharge. After adjusting for confounding variables in a logistic regression model, LAAC closure was independently associated with younger age, previous bleeding events, angiodysplasia, lower diastolic blood pressure, direct anticoagulant or aspirin use at admission and discharge from a tertiary referral centre (Table). Variables with univariate association with LAAC (p<0.10) but excluded in backward stepwise regression after showing no significant association with the dependent variable were diabetes mellitus (rate of LAAC 8.9% vs 5.3% in non-diabetics, p=0.02), hypercholesterolemia (8.0% vs 5.3%, p=0.08), ischaemic heart disease (10.4% vs 6.0%, p=0.03), at least moderate valvular disease (9.0% vs 5.9%, p=0.08), dementia (2.9% vs 7.5%, p=0.03), liver disease (10.3% vs 6.3%, p=0.099), anemia (7.2% vs 4.1%, p=0.14), and vitamin K antagonist use at admission (3.8% vs 7.6%, p=0.04). Conclusions In anticoagulated patients with AF who survived a severe GIB in all public hospitals with LAAC program in a large European region in 2021-2022, and who were also eligible for anticoagulation with DOAC, only 6.7% were managed with a LAAC strategy. Several baseline features were independently associated with higher or lower frequency of this approach.Table

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Cite This Study

Munoz et al. (2025) studied this question. Only 6.7% of anticoagulated AF patients surviving severe gastrointestinal bleeding received left atrial appendage closure, associated with younger age and prior bleeding.

synapsesocial.com/papers/698828010fc35cd7a8847151 https://doi.org/10.1093/eurheartj/ehaf784.540