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Left atrial appendage occlusion for atrial fibrillation and bleeding diathesis
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  • Balrik Singh Kailey,
  • Michael Koa-Wing,
  • Nilesh Sutaria,
  • Tom Mott,
  • Sohaib SMA,
  • Norman Qureshi,
  • Christine Shi,
  • Pritpal Padam,
  • James Howard,
  • Prapa Kanagaratnam
Balrik Singh Kailey
Imperial College London

Corresponding Author:bkailey@ic.ac.uk

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Michael Koa-Wing
Imperial College London
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Nilesh Sutaria
Imperial College London
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Tom Mott
Abbott Cardiovascular UK Ltd
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Sohaib SMA
Imperial College London
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Norman Qureshi
Imperial College London
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Christine Shi
Imperial College London
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Pritpal Padam
Imperial College London
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James Howard
Imperial College London
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Prapa Kanagaratnam
Imperial College London
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Abstract

Background: Patients with AF and likelihood of bleeding can undergo left atrial appendage occlusion (LAAO) as an alternative method of stroke prophylaxis. Short-term anti-thrombotic drugs are used post-procedure to offset the risk of device-related thrombus, evidence for this practice is limited. Objectives: To investigate optimal post-implant antithrombotic strategy in high bleeding-risk patients. Methods: Patients with AF and high-risk for both stroke and bleeding undergoing LAAO were advised their peri-operative drug therapy by a multi-disciplinary physician panel. Those deemed to be at higher risk of bleeding from anti-thrombotic drugs were assigned to minimal treatment with no antithrombotics or aspirin-alone. The remaining patients received standard care (STG)with a 12week course of dual-antiplatelets or anticoagulation post-implant. We compared mortality, device-related thrombus, ischemic stroke and bleeding events during the 90 days post-implant and long-term. Event-free survival was assessed using Kaplan-Meier survival analysis, with logrank testing for statistical significance. Results: 75 pts underwent LAAO of whom 63pts(84%) had a prior serious bleeding event. The 42pts on minimal treatment were older(74.3±7.7vs71.2±7.2) with higher HASBLED score (3.6±0.9vs3.3±1.2) than the 33pts having standard care. There were no device-related thrombi or strokes in either group at 90 days post-procedure; STG had more bleeding events (5/33vs0/42,p=0.01) with associated deaths (3/33vs0/42,p=0.05). During long-term follow up (median 2.2yrs), all patients transitioned onto no antithrombotic drugs (43pts(61%)) or a single-antiplatelet (29pts(39%)). There was no evidence of early minimal treatment adversely affecting long-term outcomes. Conclusions: Short-term anti-thrombotic drugs may not be needed after LAAO implant in patients with high bleeding risk and could be harmful. Larger, prospective studies would be warranted to test these findings.
07 Jun 2023Submitted to Journal of Cardiovascular Electrophysiology
07 Jun 2023Submission Checks Completed
07 Jun 2023Assigned to Editor
07 Jun 2023Review(s) Completed, Editorial Evaluation Pending
30 Jun 2023Reviewer(s) Assigned
08 Aug 2023Editorial Decision: Revise Minor
23 Aug 20231st Revision Received
05 Sep 2023Submission Checks Completed
05 Sep 2023Assigned to Editor
05 Sep 2023Review(s) Completed, Editorial Evaluation Pending
05 Sep 2023Reviewer(s) Assigned