Abstract
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.