Key result
Periprocedural red blood cell transfusion after Watchman LAAC is linked to ~6-fold higher mortality.
Why the study?
Does percutaneous left atrial appendage closure with the Watchman device reduce bleeding events and transfusion needs in high-risk nonvalvular atrial fibrillation patients, and are persistent postprocedural red blood cell transfusions associated with increased long-term mortality?
Cohort (n=70)
No
Does percutaneous left atrial appendage closure with the Watchman device reduce bleeding events and transfusion needs in high-risk nonvalvular atrial fibrillation patients, and are persistent postprocedural red blood cell transfusions associated with increased long-term mortality?
Left atrial appendage closure with the Watchman device significantly reduces bleeding burden in high-risk atrial fibrillation patients, but persistent postprocedural bleeding requiring red blood cell transfusion (predominantly during the 6-month dual antiplatelet therapy phase) is independently associated with a six-fold increase in long-term mortality.
Answers are grounded in this paper and cite their sources.
Transfusions after Watchman LAAC identify high-mortality patients; small observational cohort leaves open whether bleeding mitigation improves survival.
Background: Left atrial appendage closure (LAAC) is an established alternative to oral anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation who are at high risk of thromboembolic events or bleeding complications. Methods: In this single-center retrospective study, we analyzed 70 consecutive patients who underwent successful LAAC with the Watchman™ device between 2012 and 2024. Acute procedural outcomes, long-term thromboembolic and bleeding events, transfusion requirements and mortality were evaluated. Mean follow-up duration was 1210 days. Results: Procedural success was achieved in 98.6% of cases with a low periprocedural complication rate. Ischemic stroke/transient ischemic attack occurred in 2.8% of patients; no hemorrhagic strokes or stroke-related deaths were observed. LAAC resulted in a significant reduction in both the number (144 vs. 56 events; 2.36 vs. 1.55 events per patient, p < 0.05) and severity of bleeding events. Nonetheless, 42.9% of patients required bleeding-related hospitalization after implantation, predominantly within the first 6 months during dual antiplatelet therapy. Overall mortality was 40% with a 12% yearly mortality rate; heart failure and infections were leading causes of death. Pre- and postprocedural transfusion requirements were independently associated with a six-fold increase in mortality risk (HR = 5.97). Conventional risk scores (CHA2DS2-VASc, HAS-BLED) failed to predict transfusion needs; atrial enlargement, right ventricular dysfunction, smoking and alcohol consumption were associated with higher risk. Conclusions: LAAC is a safe and effective alternative to long-term anticoagulation, significantly reducing bleeding burden without increasing thromboembolic mortality. Persistent postprocedural bleeding remains a major determinant of long-term prognosis, underscoring the need for individualized, multidisciplinary post-implant management.
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Bogdan et al. (2026) conducted a cohort in Nonvalvular atrial fibrillation undergoing left atrial appendage closure (LAAC) due to high bleeding risk or recurrent thromboembolic events (n=70). Pre- and postprocedural red blood cell transfusion following Watchman left atrial appendage closure vs. No red blood cell transfusion before or after left atrial appendage closure was evaluated on All-cause mortality associated with pre- and postprocedural red blood cell transfusion requirements after LAAC (HR 5.97, p=0.00019). Pre- and postprocedural red blood cell transfusion needs after Watchman LAAC were independently associated with a six-fold increase in mortality risk.
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