Discontinuation of Antithrombotic Management Following Left Atrial Appendage Occlusion in High Bleeding Risk Patients.

Background: Antithrombotic therapy is required after left atrial appendage occlusion (LAAO) whilst endothelialization of the device occurs. LAAO patients are usually at high bleeding risk and the optimal antithrombotic regimen post-implantation remains debated.

Aims: We aimed to study the efficacy of using maximum of 6-month antithrombotic treatment post-LAAO in high bleeding risk patients with atrial fibrillation.

Methods: Data from patients who had LAAO at our center between 2015 and 2024 were examined. Those who were discharged on a plan of 6 months antithrombotic therapy were included. Incidence of stroke, transient ischaemic attack (TIA), major bleeding or death during follow-up was measured.

Results: A total of 128 patients met the analysis criteria. One hundred and six (82.8%) patients had a previous major bleeding event with or without oral anticoagulation. Seventy-eight (60.9%) patients had a previous stroke. The median CHADS-VASc and HAS-BLED scores were 4 and 3 respectively. Complete closure of the left atrial appendage was achieved in 116 (90.6%) patients with no peri-device flow. Follow-up was obtained for 484 patient-years (median follow-up time 3.6 years). Post-procedure, 126 (98.4%) patients had antiplatelet therapy only, for 6 months or less. Stroke or TIA occurred in 5.5% of patients (1.45 per 100 patient-years)-a 69% reduction compared to the predicted risk. 10.2% of patients suffered from major bleeding (2.69 per 100 patient-years). 36.7% (9.71 per 100 patient-years) of patients died.

Conclusion: Complete cessation of antithrombotic treatment 6 months after LAAO was associated with a low incidence of subsequent stroke or TIA in patients at high bleeding risk.