Key result
LAAC after GI bleeding in AF linked to ~43% lower risk of composite events or death.
Why the study?
There are no real-world data on the impact of percutaneous left atrial appendage closure after hospitalization for gastrointestinal bleeding in anticoagulated patients with atrial fibrillation.
Does left atrial appendage closure reduce composite recurrent events and mortality in anticoagulated atrial fibrillation patients after hospitalization for gastrointestinal bleeding compared to medical management?
Cohort (n=1,041)
Yes
Does left atrial appendage closure reduce composite recurrent events and mortality in anticoagulated atrial fibrillation patients after hospitalization for gastrointestinal bleeding compared to medical management?
Hazard Ratio: 0.57 (95% CI 0.37–0.89)
p-value: p=0.013
In a real-world cohort of anticoagulated atrial fibrillation patients hospitalized for gastrointestinal bleeding, left atrial appendage closure was rarely utilized but associated with a significantly lower risk of composite adverse events and mortality.
BACKGROUND: There are no "real world" data on the actual impact of percutaneous left atrial appendage closure (LAAC) programs in the management of thromboembolic prevention after a hospital admission for gastrointestinal bleeding (GIB) in anticoagulated patients with atrial fibrillation (AF). We evaluated the utilization, predictors, and clinical outcomes of LAAC following GIB-related hospitalizations. METHODS: The multicenter PERSEO registry retrospectively enrolled consecutive anticoagulated AF patients discharged alive after a GIB (2021-2022) across all public Andalusian hospitals with LAAC programs. Baseline features and clinical outcomes were compared between LAAC and medical management using multivariable logistic, and time-dependent Andersen-Gill and Cox regression models. RESULTS: Among 1041 patients (median age 82 years, 48.7% male), only 70 (6.7%) underwent LAAC, at a median of 5 months post-discharge. LAAC was independently associated with younger age, previous bleeding, angiodysplasia, lower diastolic blood pressure, aspirin or direct oral anticoagulant use at admission, and tertiary referral-center care. LAAC was associated with a lower hazard of recurrent composite events (stroke/transient ischemic attack, systemic embolism, major or clinically relevant non-major bleeding, or death -HR 0.57, 95% CI 0.37-0.89, p=0.013) and with a lower hazard of all-cause mortality (HR 0.40, 95% CI 0.22-0.72, p=0.002). CONCLUSIONS: In real-world clinical practice, LAAC was infrequently used after hospitalization for GIB in anticoagulated patients with AF, being selectively reserved for specific clinical phenotypes. Nevertheless, this strategy was associated with a lower risk of adverse outcomes after adjusting for measured confounders. These findings should be interpreted cautiously given the observational design of the study.
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Esperón et al. (2026) conducted a cohort in Atrial fibrillation with prior gastrointestinal bleeding (n=1,041). Percutaneous left atrial appendage closure vs. Medical management was evaluated on Recurrent composite events (stroke/transient ischemic attack, systemic embolism, major or clinically relevant non-major bleeding, or death) (HR 0.57, 95% CI 0.37-0.89, p=0.013). Left atrial appendage closure following gastrointestinal bleeding in anticoagulated AF patients was associated with a lower hazard of recurrent composite events or death (HR 0.57; 95% CI 0.37-0.89; P=0.013).
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