{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:26:23Z","timestamp":1791779183653,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T00:00:00Z","timestamp":1699920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with atrial fibrillation\u00a0(AF) and likelihood of bleeding can undergo left atrial appendage occlusion (LAAO) as an alternative method of stroke prophylaxis. Short\u2010term anti\u2010thrombotic drugs are used postprocedure to offset the risk of device\u2010related thrombus, evidence for this practice is limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate optimal postimplant antithrombotic strategy in high bleeding\u2010risk patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with AF and high\u2010risk for both stroke and bleeding undergoing LAAO were advised their perioperative drug therapy by a multidisciplinary physician panel. Those deemed to be at higher risk of bleeding from anti\u2010thrombotic drugs were assigned to minimal treatment with no antithrombotics or Aspirin\u2010alone. The remaining patients received standard care (STG) with a 12 week course of dual\u2010antiplatelets or anticoagulation postimplant. We compared mortality, device\u2010related thrombus, ischemic stroke, and bleeding events during the 90 days postimplant and long\u2010term. Event\u2010free survival was assessed using Kaplan\u2212Meier survival analysis, with logrank testing for statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010five patients\u00a0underwent LAAO of whom 63 patients\u00a0(84%) had a prior serious bleeding event. The 42 patients\u00a0on minimal treatment were older (74.3\u2009\u00b1\u20097.7 vs. 71.2\u2009\u00b1\u20097.2) with higher HASBLED score (3.6\u2009\u00b1\u20090.9 vs. 3.3\u2009\u00b1\u20091.2) than the 33 patients\u00a0having standard care. There were no device\u2010related thrombi or strokes in either group at 90 days postprocedure; STG had more bleeding events (5\/33 vs. 0\/42,\u00a0<jats:italic>p<\/jats:italic>\u2009=\u20090.01) with associated deaths (3\/33 vs. 0\/42,\u00a0<jats:italic>p<\/jats:italic>\u2009=\u20090.05). During long\u2010term follow\u2010up (median 2.2\u2009years), all patients transitioned onto no antithrombotic drugs (43 patients [61%]) or a single\u2010antiplatelet (29 patients\u00a0[39%]). There was no evidence of early minimal treatment adversely affecting long\u2010term outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Short\u2010term anti\u2010thrombotic drugs may not be needed after LAAO implant in patients with high bleeding risk and could be harmful. Larger, prospective studies would be warranted to test these findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16105","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T12:52:54Z","timestamp":1699966374000},"page":"2552-2562","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Left atrial appendage occlusion for atrial fibrillation and bleeding diathesis"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8274-2897","authenticated-orcid":false,"given":"Balrik Singh","family":"Kailey","sequence":"first","affiliation":[{"name":"Imperial College Healthcare NHS Trust London UK"},{"name":"Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Koa\u2010Wing","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilesh","family":"Sutaria","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Mott","sequence":"additional","affiliation":[{"name":"Abbott Medical Solihull UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afzal","family":"Sohaib","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Shi","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1933-2294","authenticated-orcid":false,"given":"Pritpal","family":"Padam","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Howard","sequence":"additional","affiliation":[{"name":"Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3593-2185","authenticated-orcid":false,"given":"Prapa","family":"Kanagaratnam","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust London UK"},{"name":"Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euz258"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.029"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.021"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.03.035"},{"key":"e_1_2_11_6_1","unstructured":"Abbott\u00a9 AmplatzerTM. 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