Aims: Percutaneous left atrial appendage (LAA) closure systems has been established as alternative stroke prophylaxis in patients with non-valvular atrial fibrillation (AF) particularly in those with high bleeding risk. However, little is known regarding the outcome after LAA closure depending on the HAS-BLED score.

Methods: A sub-analysis from the prospective, multicenter, Left-Atrium-Appendage Occluder Register - GErmany (LAARGE) registry was performed assessing three different groups with respect to the HAS-BLED score (0-2 [group 1] vs. 3-4 [group 2] vs. 5-7 [group 3]).

Results: A total of 633 patients at 38 centers were enrolled. Of them, 9% (n=59) were in group 1, 63% (n=400) in group 2 and 28% (n=174) in group 3. The Kaplan Meier estimated 1-year composite of death, stroke and systemic embolism was 3.4% vs. 10.4% vs. 20.1%, respectively (p log rank <0.001). The difference was driven by death, since stroke (1.8% vs. 0.6% vs. 1.6%; p=0.08) and systemic embolism (0% vs. 0% vs. 0.8%; p=1.00) did not show a significant difference between the groups. The rate of major bleedings at 1 year was 0% vs. 0% vs. 2.4%, respectively (p=0.016).

Conclusions: The present data show that patients with high baseline bleeding risk had similarly low rates of ischemic complications and only slightly increased bleeding events compared to intermediate and low baseline bleeding risk 1 year after LAA closure. Higher HAS-BLED scores were associated with increased mortality due to higher age and more severe comorbidity of these patients.