Impact of female sex in frequency and effectiveness of left atrial appendage closure after severe bleeding in anticoagulated patients with atrial fibrillation: real world data from PERSEO registry

Abstract Background There are no "real world" data on the actual impact of female sex in percutaneous left atrial appendage closure (LAAC) interventions after a severe bleeding (SB) in anticoagulated patients with atrial fibrillation (AF). Purpose Our main objective was to investigate the impact of female sex in frequency and effectiveness of LAAC in anticoagulated AF patients surviving a SB event in Andalusia (South of Spain). Methods The PERSEO registry (Prevention of embolic events after a severe hemorrhage in anticoagulated patients with atrial fibrillation -in Spanish, Prevención de eventos Embólicos tras una hemoRragia SEvera en pacientes anticoagulados con fibrilaciOn auricular) was an observational, retrospective, multicentre study that included all consecutive patients discharged alive from January 1st, 2021 to December 31st, 2022, after an ICH 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. We investigated the differential baseline features, frequency of LAAC strategy, and events in follow-up in the whole series and in those treated with LAAC, between male and female patients. Results Among a reference population of 7119044 inhabitants in 15 hospitals, 1403 patients were included in the study. Median age was 81 years p25-75, 76-87 years with 48.4% female patients. A LAAC procedure was performed in 114 patients (8.1%) at a median time of 5 2-10 months after discharge. Female patients presented significant differences in several key baseline variables (Table). However, the frequency of LAAC was similar than in male patients (7.2 vs 9.0, p=0.226), even after adjusting by confounders (OR 0.88, 95%CI 0.54-1.43, p=0.608). After a median p25-75 follow-up of 19 8-26 months, overall survival and survival free from any embolic or bleeding event was 69% and 53%, without significant differences between both sexes (figure, panels A and B). After the LAAC procedure, overall survival and survival free from any embolic or bleeding event was 87% and 67% at median follow up (17 9-23 months), without significant differences between both groups (figure, panels C and D). Conclusions In anticoagulated patients with AF who survived a SB event in all public hospitals with LAAC program in a large European region in 2021-2022, and who were also eligible for anticoagulation with direct anticoagulants, we did not found any sex bias in the utilization of LAAC strategy nor any significant differences in outcomes between female and male patients.Table Figure