Left atrial appendage closure after severe bleeding in anticoagulated patients with atrial fibrillation and cancer: real world data from PERSEO registry

Abstract Background There are paucity of "real world" data on the actual impact of percutaneous left atrial appendage closure (LAAC) in the management of anticoagulated patients with atrial fibrillation (AF) and cancer after a severe bleeding (SB) event. Purpose Our main objective was to investigate the frequency, associated factors and impact on events of a LAAC strategy in anticoagulated AF patients with cancer surviving a SB versus those medically managed in Andalusia (South of Spain). Methods The PERSEO registry (Prevention of embolic events after a severe hemorrhage in anticoagulated patients with atrial fibrillation) was an observational, retrospective, multicentre study that included all consecutive patients discharged alive from January 1st, 2021 to December 31st, 2022, after an intracranial haemorrhage or severe gastrointestinal bleeding, who were previously anticoagulated for AF, in all public Andalusian hospitals with LAAC program, and who could be eligible either for LAAC or direct anticoagulant treatment. This analysis focuses in patients with a diagnosis of cancer in the 5 previous years. The frequency of a percutaneous LAAC strategy in the follow-up was registered, the differential features with those patients medically managed and the impact of this strategy on events in follow-up was investigated. Results Among a reference population of 7119044 inhabitants in 15 hospitals, 1403 patients were included in the study, and 224 had a cancer diagnosis in the 5 previous years and conform this study sample. Median age was 82 years p25-75, 76-86 years with 65.6% male patients. A LAAC procedure was performed in 15 patients (6.7%) at a median time of 9 4-13 months after discharge. LAAC closure was independently associated with younger age, heart failure or left ventricular dysfunction, leukaemia and previous bleeding events (Table). After the procedure, the 15 patients treated with the LAAC strategy had a numerically better overall survival (81% versus 55%, p=0.260), survival free from embolic events (73% versus 54%, p=0.497), any bleeding (60% versus 43%, p=0.325) and any embolic or bleeding event (52% versus 38%, p=0.465) at 18 months, although all comparisons were non-significant (figure, panels A, B, C and D, respectively). Conclusions In anticoagulated patients with AF and cancer who survived a SB in all public hospitals with LAAC program in a large European region in 2021-2022, and who were also eligible for anticoagulation with DOAC, only 6.7% were managed with a LAAC strategy. Several baseline features were independently associated with this approach. Although we observed numerically fewer events in patients treated with LAAC, the statistical power was insufficient for conclusive results in this point.Table Figure