Key result
Discontinuing anticoagulation in AF with congenital LAA absence yields no thromboembolic events at 18 months.
Why the study?
Atrial fibrillation increases thromboembolic risk usually from left atrial appendage thrombi, and congenital absence of the LAA is a rare anatomical variant that may influence anticoagulation strategies.
Does discontinuation of anticoagulation prevent bleeding without increasing thromboembolic events in a patient with permanent atrial fibrillation and congenital absence of the LAA?
Case Report (n=1)
Does discontinuation of anticoagulation prevent bleeding without increasing thromboembolic events in a patient with permanent atrial fibrillation and congenital absence of the LAA?
Congenital absence of the LAA is a rare anatomical variant that may allow for the safe discontinuation of anticoagulation in selected patients with atrial fibrillation and high bleeding risk.
Congenital LAA absence may alter anticoagulation or occlusion decisions in AF; leaves open systematic thromboembolic risk assessment.
BACKGROUND: Atrial fibrillation (AF) increases the risk of thromboembolic events, most commonly owing to thrombus formation in the left atrial appendage (LAA). Anticoagulation reduces thromboembolic risk but increases bleeding risk. Congenital absence of the LAA is a rare anatomical variant that may influence anticoagulation strategies. CASE SUMMARY: A 78-year-old man with permanent AF and recurrent obscure gastrointestinal bleeding was evaluated for potential LAA occlusion. Transesophageal echocardiography and cardiac magnetic resonance imaging demonstrated congenital absence of the LAA without evidence of atrial thrombus. Considering the patient's high bleeding risk, anticoagulation therapy was discontinued after multidisciplinary assessment. No cardiac thrombus formation was detected on imaging at 6 months, and the patient remained clinically free of thromboembolic events at 18 months. DISCUSSION: This case illustrates the importance of multimodal imaging in identifying congenital LAA absence and guiding individualized anticoagulation decisions. TAKE-HOME MESSAGE: Congenital LAA absence may allow individualized reconsideration of anticoagulation in selected AF patients with high bleeding risk.
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Nashtar et al. (2026) conducted a case report in Atrial fibrillation with gastrointestinal bleeding and congenital absence of the left atrial appendage (n=1). Discontinuation of anticoagulation therapy was evaluated on Thromboembolic events and cardiac thrombus formation. Discontinuation of anticoagulation in a 78-year-old man with permanent atrial fibrillation and congenital absence of the left atrial appendage resulted in no thromboembolic events at 18 months.
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