Key result
Standalone thoracoscopic epicardial appendage occlusion without antithrombotic therapy significantly reduced the relative risk of bleeding by 83% (RR 0.17, p=0.02) and stroke by 81% compared to expected rates based on risk scores.
Why the study?
Endovascular left appendage occlusion requires antithrombotic therapy carrying rebleeding risks, and data on left appendage occlusion without any antithrombotic therapy in patients with atrial fibrillation and gastrointestinal bleeding were lacking.
Does standalone epicardial left atrial appendage occlusion without antithrombotic therapy reduce stroke and rebleeding in atrial fibrillation patients with recurrent gastrointestinal bleeding?
Cohort (n=129)
Yes
Does standalone epicardial left atrial appendage occlusion without antithrombotic therapy reduce stroke and rebleeding in atrial fibrillation patients with recurrent gastrointestinal bleeding?
Relative Risk: 0.17 (95% CI 0.03–0.73)
Absolute Event Rate: 0.91% vs 5.5%
Number Needed to Treat: 12.9
p-value: p=0.02
Standalone thoracoscopic epicardial left atrial appendage occlusion without postoperative antithrombotic therapy appears safe and significantly reduces both stroke and rebleeding risk in AF patients with recurrent GI bleeding.
May support LAA occlusion without antithrombotics in high-bleed-risk AF; leaves open randomized confirmation of stroke prevention.
Background: Gastrointestinal bleeding in patients with atrial fibrillation is an indication for left appendage occlusion. All endovascular devices mandate antithrombotic therapies: rebleeding risk remains an issue. To date, there are no reports on gastrointestinal rebleeding and stroke prevention by left appendage occlusion without any antithrombotic therapy in this category of patients. Methods: A total of 129 patients (male 85, mean age 76.6 ± 7.1, CHA2DS2Vasc 3.8 ± 1.5, HASBLED 3.3 ± 1.0; upper GI bleeding 10%, lower GI bleeding 86%, obscure occult 4.6%, on NOACS full dose 77.5%, NOACs reduced dose 13.1%, on anti-vitamin K 9.3%) with atrial fibrillation and history of repetitive gastrointestinal bleeding from ten centers underwent standalone thoracoscopic epicardial appendage closure without antithrombotic therapy for the entire follow up. Results: The observed bleeding rate was 0.91 events per year, equivalent to a relative risk of RR = 0.17 (p = 0.02) and a relative risk reduction (RRR) of 83%. The observed relative risk of stroke was 0.91 events per year, with a relative risk of RR = 0.19 (p = 0.03) and a relative risk reduction (RRR) of 81%. Conclusion: Standalone epicardial appendage occlusion without antithrombotic therapy in patients with repetitive gastrointestinal bleeding is safe and promising when rebleeding and stroke risk reduction need to be optimized.
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Branzoli et al. (2025) conducted a cohort in Atrial fibrillation and history of recurrent gastrointestinal bleeding (n=129). Standalone thoracoscopic epicardial appendage occlusion without antithrombotic therapy was evaluated on Bleeding events (RR 0.17, 95% CI 0.03-0.73, p=0.02). Standalone thoracoscopic epicardial appendage occlusion without antithrombotic therapy significantly reduced the relative risk of bleeding by 83% (RR 0.17, p=0.02) and stroke by 81% compared to expected rates based on risk scores.
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