Key result
Elevated admission SBP linked to ~10-fold greater bleeding risk post-LAAC, predominantly occurring during DAPT.
Why the study?
The study aimed to investigate the incidence and predictors of clinically significant bleeding after transcatheter left atrial appendage closure.
What are the incidence and predictors of clinically significant bleeding after transcatheter left atrial appendage closure in patients unsuitable for long-term anticoagulation?
Cohort (n=195)
What are the incidence and predictors of clinically significant bleeding after transcatheter left atrial appendage closure in patients unsuitable for long-term anticoagulation?
Clinically significant bleeding after LAAC occurs in approximately 7.2% of patients, predominantly during postprocedural DAPT, and is predicted by elevated admission systolic blood pressure, prior epistaxis, permanent AF, and prior gastrointestinal bleeding.
Background: Transcatheter left atrial appendage closure (LAAC) is performed in patients unsuitable for long-term anticoagulation, predominantly due to prior bleeding events. The study aimed to investigate the incidence and predictors of clinically significant bleeding (CSB) post-LAAC. Methods: Consecutive patients after LAAC with an Amplatzer or WATCHMAN device were analyzed (05.2014–11.2019). Bleeding was classified as CSB when associated with at least one of the following: death, ≥2 g/dL hemoglobin drop, ≥2 blood units transfusion, critical anatomic site, or hospitalization/invasive procedure. Results: Among 195 patients (age 74 (68–80), 43.1% females, HAS-BLED score 2.0 (2.0–3.0)), during median follow-up of 370 (IQR, 358–392) days, there were 15 nonprocedural CSBs in 14 (7.2%) patients. Of those, 9 (60.0%) occurred during postprocedural dual antiplatelet therapy (DAPT) (median 46 (IQR: 16–60) days post-LAAC) vs. 6 (40%) after DAPT discontinuation (median 124 (81–210) days post-LAAC), translating into annualized CSB rates of 14.0% (per patient-year on DAPT) vs. 4.6% (per patient-year without DAPT). In 92.9% (13/14) of patients, the post-LAAC nonprocedural CSB was a recurrence from the same site as bleeding pre-LAAC. In the multivariable model, admission systolic blood pressure (SBP) > 127 mmHg (HR = 10.73, 1.37–84.26, p = 0.024), epistaxis history (HR = 5.84, 1.32–25.89, p = 0.020), permanent atrial fibrillation (AF) (HR = 4.55, 1.20–17.20, p = 0.025), and prior gastrointestinal bleeding (HR = 3.35, 1.01–11.08, p = 0.048) predicted post-LAAC CSB. Conclusions: Nonprocedural CSBs after LAAC, with a similar origin as the pre-LAAC bleedings, were observed predominantly during postprocedural DAPT and predicted by elevated admission SBP, prior epistaxis, permanent AF, and gastrointestinal bleeding history. Whether a more reserved post-LAAC antiplatelet regimen and stringent blood pressure control may improve LAAC outcomes remains to be studied.
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Zieliński et al. (2022) conducted a cohort in Patients unsuitable for long-term anticoagulation undergoing LAAC (n=195). Transcatheter left atrial appendage closure (LAAC) was evaluated on Clinically significant bleeding (CSB) post-LAAC. Clinically significant bleeding occurred in 7.2% of patients post-LAAC, predominantly during DAPT, and was predicted by elevated admission SBP (HR 10.73), prior epistaxis, and permanent AF.
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