Left Atrial Appendage Closure in Patients With Intracranial Hemorrhage and Nonvalvular Atrial Fibrillation

Abstract

Background: Left atrial appendage (LAA) closure is primarily performed in patients who have contraindications to anticoagulants. However, anticoagulants are recommended for the first few weeks after LAA closure to prevent the device related thrombus. Purpose of this study was to evaluate if short term use of anticoagulant is safe and effective after LAA closure in patients with a history of intracranial hemorrhage.

Methods: It is a retrospective observational study done at a single center. Baseline characteristics, perioperative, and postoperative complications of patients with a history of intracranial hemorrhage and Watchman device implant were analyzed, and patients were followed for a mean follow-up of 27 months.

Results: LAA closure was performed in 16 patients using the Watchman device (Boston Scientific, MA). Mean age was 74.6 ± 5.8 years, median CHA2DS2-VASc score was 4.5 (interquartile range of 3), median HAS-BLED score was 4 (interquartile range of 1). Patients received aspirin 81 mg with oral anticoagulant for 45 days, dual antiplatelet therapy for 4.5 months, and thereafter aspirin indefinitely. No perioperative and postoperative complications were noted.

Conclusion: Based on our single center experience, we conclude that antithrombotic drugs in the short term appear safe and effective in selected patients after LAA closure in patients with previous intracranial hemorrhage.

Keywords: Atrial fibrillation; Warfarin; direct oral anticoagulants; intracranial hemorrhage; left atrial appendage closure.