Transfusion requirements before and after left atrial appendage closure were independently associated with a six-fold increase in mortality risk (HR = 5.97).
Does left atrial appendage closure (LAAC) reduce bleeding events, and how do post-procedural transfusion requirements affect mortality in patients with nonvalvular atrial fibrillation?
Patients with nonvalvular atrial fibrillation at high risk of thromboembolic events or bleeding complications
Left atrial appendage closure (LAAC) with the Watchman device
Pre-procedural state (historical self-control for bleeding events)
Acute procedural outcomes, long-term thromboembolic and bleeding events, transfusion requirements, and mortalityhard clinical
While LAAC reduces overall bleeding burden, persistent postprocedural bleeding requiring red blood cell transfusion is strongly associated with increased long-term mortality.
Background: Left atrial appendage closure (LAAC) is an established alternative to oral anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation who are at high risk of thromboembolic events or bleeding complications. Methods: In this single-center retrospective study, we analyzed 70 consecutive patients who underwent successful LAAC with the Watchman™ device between 2012 and 2024. Acute procedural outcomes, long-term thromboembolic and bleeding events, transfusion requirements and mortality were evaluated. Mean follow-up duration was 1210 days. Results: Procedural success was achieved in 98.6% of cases with a low periprocedural complication rate. Ischemic stroke/transient ischemic attack occurred in 2.8% of patients; no hemorrhagic strokes or stroke-related deaths were observed. LAAC resulted in a significant reduction in both the number (144 vs. 56 events; 2.36 vs. 1.55 events per patient, p < 0.05) and severity of bleeding events. Nonetheless, 42.9% of patients required bleeding-related hospitalization after implantation, predominantly within the first 6 months during dual antiplatelet therapy. Overall mortality was 40% with a 12% yearly mortality rate; heart failure and infections were leading causes of death. Pre- and postprocedural transfusion requirements were independently associated with a six-fold increase in mortality risk (HR = 5.97). Conventional risk scores (CHA2DS2-VASc, HAS-BLED) failed to predict transfusion needs; atrial enlargement, right ventricular dysfunction, smoking and alcohol consumption were associated with higher risk. Conclusions: LAAC is a safe and effective alternative to long-term anticoagulation, significantly reducing bleeding burden without increasing thromboembolic mortality. Persistent postprocedural bleeding remains a major determinant of long-term prognosis, underscoring the need for individualized, multidisciplinary post-implant management.
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Manuella Bogdan
Balázs Polgár
Előd János Zsigmond
Journal of Clinical Medicine
Semmelweis University
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Bogdan et al. (Mon,) reported a other. Transfusion requirements before and after left atrial appendage closure were independently associated with a six-fold increase in mortality risk (HR = 5.97).
www.synapsesocial.com/papers/69ccb63f16edfba7beb87ec9 — DOI: https://doi.org/10.3390/jcm15072626