Recurrent Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Left Atrial Appendage Occlusion

Author Department

Cardiology; Medicine

Document Type

Article, Peer-reviewed

Publication Date

2-2026

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.

Keywords: LAAO; anticoagulation; atrial fibrillation; gastrointestinal bleeding.

PMID

41721735

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