Recurrent Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Left Atrial Appendage Occlusion
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Concomitant atrial fibrillation (AF) and gastrointestinal (GI) bleeding present a clinical challenge due to recurrent bleeding risk associated with anticoagulation for AF-associated stroke prevention. Left atrial appendage occlusion (LAAO) offers an alternative stroke prevention strategy, but its impact on recurrent GI bleeding remains unknown. METHODS: This retrospective, multicenter cohort study used the TriNetX database to identify adults with AF on oral anticoagulation and a history of GI bleeding. Patients were stratified by treatment with or without LAAO. 1:1 propensity score matching (PSM) was employed. The primary outcome was recurrent GI bleeding. Cox regression analysis was used to generate hazard ratios (HRs) with 95% confidence intervals (CIs). Odds ratios (ORs) were used to evaluate effect sizes between groups. Kaplan-Meier curves were used for time-to-event analyses. RESULTS: After PSM, 9259 patients were compared in each group. Odds of recurrent GI bleeding were consistently lower in patients undergoing LAAO than without LAAO across all follow-up intervals: at 3 months (OR 0.84; 95% CI 0.78-0.91), 6 months, 1 year, 3 years, and 5 years (OR 0.87; 95% CI 0.82-0.92). Kaplan-Meier analysis demonstrated significantly lower risk of recurrent GI bleeding with LAAO (HR 0.80; 95% CI 0.76-0.84; p < 0.01). CONCLUSION: In patients with AF and prior GI bleeding, LAAO was associated with a significantly lower risk of recurrent GI bleeding at short-term and long-term time intervals.
DOI: 10.1111/pace.70177
Institutions: Boston Medical Center, Harvard University, Massachusetts General Hospital, Mayo Clinic, Beaumont Hospital, Troy, Corewell Health William Beaumont University Hospital, Alexandria University, Henry Ford Health, Henry Ford Hospital, University of British Columbia, Vancouver General Hospital, Baystate Medical Center, Baystate Health
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7130833439