Left atrial appendage closure after a hospital admission for bleeding in atrial fibrillation patients: frequency, associated factors and prognosis

There are no "real world" data on the actual impact of percutaneous left atrial appendage closure (LAAC) programs in the management of anticoagulated patients with atrial fibrillation (AF) after a hospital admission for bleeding. Our aim was to investigate the frequency, associated factors and prognostic impact of LAAC in the management of this population. All anticoagulated AF patients discharged alive from January 2021 to December 2022 after an intracranial or gastrointestinal haemorrhage, in the 15 public hospitals with LAAC program in Andalusia (South of Spain) were included in the study. Frequency, associated factors and prognostic impact of LAAC were investigated. Among a population of 7.119.044 inhabitants, 1403 patients were included (median age 81p25-75, 76-87 years, 51.6% male). A LAAC procedure was performed in 114 patients (8.13%, 95%CI 6.70-9.56%) at 5 2-10 months after discharge. LAAC was independently associated with tertiary referral centre, intracranial haemorrhage, previous bleeding, valvular heart disease, leukaemia and aspirin use while it was more infrequent in aged > 80 years, dementia, uncontrolled hypertension, vitamin K antagonist use and interventional treatment of the bleeding event (p < 0.05). After the procedure, the LAAC group had a better survival free from embolic/bleeding events and all-cause death (66% versus 49%) and overall survival (82% versus 64%) at 24 months (p < 0.05), consistent after multivariate adjustment: HR 0.650.46-0.92 and HR 0.520.32-0.86, respectively (p < 0.05). In our study, LAAC was infrequently performed after a severe bleeding in anticoagulated AF patients, although it was associated with better prognosis.