Real world data on left atrial appendage closure after intracranial haemorrhage in anticoagulated patients with atrial fibrillation: frequency and associated factors.

There are no "real world" data on the actual impact of percutaneous left atrial appendage closure (LAAC) programs in the management of embolic event prevention after an intracranial haemorrhage (ICH) in anticoagulated patients with atrial fibrillation (AF).

Our main objective was to investigate the frequency of LAAC in anticoagulated AF patients surviving an ICH and to describe the differential features of these patients versus those medically managed in Andalusia (South of Spain).

All consecutive patients discharged alive from January 1st, 2021 to December 31st, 2022, after a severe gastrointestinal bleeding or ICH, 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 were included in a retrospective, multicentre study. This analysis focuses in patients with ICH. The frequency of a percutaneous LAAC strategy in the follow-up was registered. A comparative analysis of baseline features between those patients treated with LAAC and those medically managed was performed.

Among a reference population of 7119044 inhabitants in 15 hospitals, 1403 patients were included in the study, and 364 had an ICH and conform this study sample. Median age was 78 years [p25-75, 73-84 years] with 59.9% male patients. A LAAC procedure was performed in 44 patients (12.1%) at a median time of 5 [3-11] months after discharge. After adjusting for confounding variables in a logistic regression model, LAAC closure was independently associated with previous bleeding events, at least moderate valvular disease, peptic ulcer disease and amyloid angiopathy, and was more infrequently performed in patients aged >80 years (Table). Variables with univariate association with LAAC (p<0.10) but excluded in backward stepwise regression after showing no significant association with the dependent variable were active smoker (rate of LAAC 23.1% vs 11.2% in non-active smokers, p=0.07), heart failure or left ventricular dysfunction (16.1% vs 10%, p=0.089), previous coronary stent implantation (23.5% vs 10.9%, p=0.032), dementia (4.9% vs 13.5%, p=0.06), leukaemia (66.7% vs 11.6%, p=0.004), lymphoma(50.0% vs 11.9%, p=0.099), uncontrolled blood pressure at admission(2.8% vs 13.1%, p=0.071), vitamin K antagonist (7.7% vs 14.5%, p=0.055), or low molecular weight heparin (25.0% vs 11.3%, p=0.068), use at admission.

In anticoagulated patients with AF who survived an ICH in all public hospitals with LAAC program in a large European region in 2021-2022, and who were also eligible for anticoagulation with DOAC, only 12.1% were managed with a LAAC strategy. Several baseline features were independently associated with higher or lower frequency of this approach.Table