Major bleeding (MB) during or after left atrial appendage closure (LAAC) is associated with significantly worse patient outcomes, according to new findings published in the American Journal of Cardiology.
“Data from the pivotal randomized controlled trials and real-world clinical practice have shown that major bleeding in the procedural setting remains one of the most common complications of LAAC,” wrote lead author Salik Nazir, MD, a cardiologist with the University of Toledo Medical Center in Ohio and Reading Hospital-Tower Health in Reading, Pennsylvania, and colleagues. “To date, scarce data exist on the impact of major bleeding on outcomes after LAAC. Therefore, we aimed to investigate the association of major bleeding following LAAC on outcomes using a contemporary nationwide database.”
The study’s authors used the Nationwide Readmission Database to track data from nearly 20,000 patients who underwent LAAC in 2016 and 2017. MB was defined as bleeding that required a transfusion. When bleeding events did not require blood transfusion, they were excluded from the analysis.
Overall, MB was reported in 2.7% of LAAC patients, a percentage that lines up with previous studies on this subject. Patients with MB tended to be younger and have a higher prevalence of heart failure, coronary artery disease, peripheral vascular disease and end-stage renal disease.
LAAC patients with MB had much higher rates of vascular procedural complications (2.6% vs. 0.3%) and pericardial tamponade that required pericardiocentesis (2.2% vs. 0.7%). There were no differences in in-hospital mortality or systemic embolization, but patients with MB did have higher rates of in-hospital stroke or transient ischemic attack (TIA) and acute kidney injury (AKI) or hemodialysis (HD). Also, lengths of stay were longer and all-cause readmissions were more common among patients with MB.
“The increased rates of in-hospital stroke/TIA may be related to interruption and reversal of anticoagulation in patients already at higher baseline thromboembolic risk,” the authors wrote. “The higher rates of AKI/HD are likely related to bleeding requiring transfusion, as previously reported in patients undergoing LAAC. Similarly, longer hospital lengths of stay and higher rates of 180-day all-cause readmissions may be due to the subsequent in-hospital complications following MB.”
Nazir et al. did note that their work has limitations, including the lack of certain procedural characteristics and long-term follow-up data. However, they concluded, their findings help paint a clearer picture of how MB can affect the health of LAAC patients.
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.