Percutaneous left atrial appendage closure in patients with gastrointestinal bleeding associated with oral anticoagulants Percutaneous left atrial appendage closure and gastrointestinal bleeding

IntroductionPercutaneous left atrial appendage closure (LAAC) has shown non-inferiority compared to oral anticoagulation (OAC) in preventing atrial fibrillation (AF)-related stroke. The objective of this study was to assess whether LAAC reduces the incidence of gastrointestinal bleeding (GIB) and/or chronic anaemia associated with OAC, as well as the consumption of healthcare resources.Materials and MethodsProspective, single-center study from 2016 to 2022, LAAC was performed. Clinical, analytical and healthcare resource consumption data were collected (endoscopies, blood transfusions, hospital admissions) prior and 6 months after LAAC.Results43 patients were included, with an average age of 77.6 years. LAAC indication was upper, low and obscure GIB in 7 (16%), 8 (19%) and 28 patients (65%) respectively. GIB source was intestinal angiodysplasias in 27 patients (63%), occult origin in 12 (28%), and others (antral vascular ectasia, portal hypertension gastropathy, etc.) in 4 patients (9%). The mean number of packed red blood cells per patient before LAAC was (mean & PLUSMN; SD) 7.29 & PLUSMN; 5 vs 0.42 & PLUSMN; 1.3 (p < 0.001); endoscopic procedures were 4.34 & PLUSMN; 2.85 vs 0.27 & PLUSMN; 0.76 (p < 0.001); and hospitalizations 2.67 & PLUSMN; 2.14 vs 0.03 & PLUSMN; 0.17 (p < 0.001), with a hospital stay of 21.5 & PLUSMN; 17.3 vs 0.09 & PLUSMN; 0.5 days (p < 0.001) at 6 months post-intervention. Haemoglobin value increased from 8.1 & PLUSMN; 1.2g/dl to 12.4 & PLUSMN; 2.2g/dl (p < 0.001) at 6 months. No thromboembolic events were registered during a median follow-up of 16.6 months (range 6-65).ConclusionsLAAC could be a safe and effective alternative to OAC in patients with non-valvular AF presenting significant, recurrent or potentially unresolvable GIB. This intervention also leads to important savings in the consumption of healthcare resources.