Lo Russo Gerardo V, Balla Abdalla Kara, Alarouri Hasan S, Liu Chia-Hao, Adi Mahmoud Zhour, Killu Ammar M, Alkhouli Mohamad
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Heart Rhythm. 2025 Feb;22(2):495-502. doi: 10.1016/j.hrthm.2024.07.028. Epub 2024 Jul 18.
Short-term antithrombotic therapy is recommended after left atrial appendage occlusion (LAAO) to reduce the risk of device-related thrombosis. However, patients referred for LAAO have excess bleeding risk. Yet, short-term bleeding events post-LAAO are not well characterized.
We aimed to evaluate the incidence of early bleeding post-LAAO and its association with long-term mortality risk. We also sought to identify predictors of early bleeding.
Patients who underwent LAAO at Mayo Clinic between 2018 and 2023 were included. Early bleeding was defined as bleeding that occurred within 3 months of discharge. A multivariable Cox proportional hazards model was used to assess the association between early bleeding and death and to estimate the hazard ratio. Multivariable regression analysis was used to identify predictors of early bleeding.
Of the 592 patients included, 389 (66%) were male, and the mean age was 75.6 years. Eighty-three patients (14.0%) experienced early bleeding, with the majority having minimal (63.4%) or minor (17.3%) bleeding. At a median follow-up of 14.4 months (interquartile range 4.2-27.9 months), early bleeding after LAAO was associated with an increased risk of all-cause mortality (adjusted hazard ratio 2.07; 95% confidence interval 1.15-3.75; P = .02). A history of intracranial bleeding, nonparoxysmal atrial fibrillation, CHADS-VASc score, and early device-related thrombosis were independent predictors of early bleeding. Antithrombotic therapy at discharge was not associated with early nonprocedural bleeding.
One in 7 patients experience a nonprocedural bleeding event within 90 days of LAAO. Early bleeding after LAAO is associated with a higher all-cause mortality risk during mid-term follow-up. Further studies are needed to optimize the management of patients undergoing LAAO.
左心耳封堵术（LAAO）后推荐进行短期抗栓治疗，以降低器械相关血栓形成的风险。然而，接受LAAO治疗的患者出血风险较高。然而，LAAO术后短期出血事件的特征尚不明确。
我们旨在评估LAAO术后早期出血的发生率及其与长期死亡风险的关联。我们还试图确定早期出血的预测因素。
纳入2018年至2023年在梅奥诊所接受LAAO治疗的患者。早期出血定义为出院后3个月内发生的出血。采用多变量Cox比例风险模型评估早期出血与死亡之间的关联，并估计风险比。采用多变量回归分析确定早期出血的预测因素。
在纳入的592例患者中，389例（66%）为男性，平均年龄为75.6岁。83例患者（14.0%）发生早期出血，大多数为轻微（63.4%）或轻度（17.3%）出血。在中位随访14.4个月（四分位间距4.2 - 27.9个月）时，LAAO术后早期出血与全因死亡风险增加相关（调整后风险比2.07；95%置信区间1.15 - 3.75；P = 0.02）。颅内出血病史、非阵发性心房颤动、CHADS - VASc评分和早期器械相关血栓形成是早期出血的独立预测因素。出院时的抗栓治疗与早期非手术相关出血无关。
七分之一的患者在LAAO术后90天内发生非手术相关出血事件。LAAO术后早期出血与中期随访期间较高的全因死亡风险相关。需要进一步研究以优化接受LAAO治疗患者的管理。
