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Potential role of left atrial appendage closure in trauma patients with atrial fibrillation on anticoagulation

Year: 2025

Type: article

Abstract: Introduction: Patients with atrial fibrillation (AF) on anticoagulation (AC) have increased mortality after trauma. Left atrial appendage closure (LAAC) procedures may reduce the need for AC in patients with AF. The purpose of this study is to evaluate the outcomes of trauma patients with AF on AC compared with patients not taking AC, and assess the frequency in which trauma patients are candidates for LAAC procedures. Methods: A retrospective review of adult trauma patients after a fall was performed. AF patients on AC (+AC) were compared with patients not on AC (-AC). A CHA2DS2-VASc score is a stroke-risk stratification tool incorporating congestive heart failure, hypertension, age >75 (2 points), prior stroke (2 points), vascular disease, age 65-74, and female sex. This score was calculated for +AC patients to analyze their candidacy for LAAC. Results: +AC patients (3452 total) were found to have increased red cell (7.3% vs 6.1%, p=0.02) and plasma (2.1% vs 1.2%, p<0.001) requirements. +AC patients had increased mortality (4.6% vs 3.5%, p=0.02). 54.8% of +AC patients had a CHA2DS2VASc score of >3 and met criteria for LAAC. Conclusion: A substantial proportion of AF patients on AC meet existing criteria for LAAC. Further exploration of referral pathways may be warranted to analyze whether offering information on such procedures could reduce the risk of AC-related complications in high-risk trauma populations. Evidence level: III.

Source: Trauma Surgery & Acute Care Open