Does left atrial appendage closure reduce major bleeding compared to long-term warfarin in patients with nonvalvular atrial fibrillation?
LAA closure offers a similar overall bleeding risk to long-term warfarin over 3 years, but significantly reduces long-term bleeding after the procedural period and discontinuation of adjunctive pharmacotherapy.
There was no difference in the overall rate of major bleeding in patients assigned to LAA closure compared with extended warfarin therapy over 3 years of follow-up. However, LAA closure significantly reduced bleeding beyond the procedural period, particularly once adjunctive pharmacotherapy was discontinued. The favorable effect of LAA closure on long-term bleeding should be considered when selecting a stroke prevention strategy for patients with nonvalvular AF. (WATCHMAN Left Atrial Appendage System for Embolic PROTECTion in Patients With Atrial Fibrillation; NCT00129545; and Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy PREVAIL; NCT01182441).
Price et al. (2015) studied this question.