Left atrial appendage occlusion needs lifetime management not lifetime medications

In this issue of EuroIntervention, Antúnez-Muiños et al describe outcomes with different antithrombotic regimens following left atrial appendage occlusion (LAAO) in patients who are at very high bleeding risk1. Over 1,000 patients with very high risk of bleeding were included, with at least one major or two minor Bleeding Academic Research Consortium criteria. Two separate treatment options were compared – single antiplatelet or no therapy (397 patients) versus dual antiplatelet, oral or subcutaneous anticoagulation, or any combination of these therapies (738 patients). Technical success was >99% in all cases with a wide variety of devices. Periprocedural complications were <4% in both groups. Prior major bleeding varied between the two groups and was a predictor of the endpoint; however, there were no differences in the combined or individual components (death, ischaemic stroke, transient ischaemic attack, peripheral embolism, device-related thrombosis [DRT], and major bleeding) between the study groups. The incidence of DRT was less than 4%, comparable to previously published literature, although more than 50% of the patients were lost to follow-up at 2 years.

Do these patients exist? Absolutely. In...