Background: In patients at risk for embolic stroke in atrial fibrillation, oral anticoagulation (OAC) is recommended. Closure of the left atrial appendage failed to prove net benefit in such patients. However, literature suggest a benefit of LAA closure (LAAC) when patients are intolerable to OAC.

Objective: Our hypothesis was, that LAAC is an efficient and safe method to reduce bleeding events and thereby elevating serum hemoglobin. Thus, we aimed to determine bleeding and embolic events as well as serum hemoglobin in advance and after LAAC in a real world collective.

Methods: We retrospectively analyzed patients who received LAAC in two tertiary cardiologic centers. Bleedings events, use of erythrocyte concentrates, anticoagulation and embolic events before the procedure were compared to events following LAAC. To detect device related complications, transesophageal echocardiography was performed 3 and 6 months after LAAC.

Results: 75 patients (CHA₂DS₂-VASc score 4.4±1.7, HAS-BLED score 4.6±1.1) were analyzed. Before LAAC (observation period 1.8±1.8 years, mean±SD), 67 patients experienced 1.8±1.4 bleeding events (0.9±1.3 major) per year resulting in 0.7±1.3 transfusions per year. After LAAC (2.6±2.0 years), 26 patients (P < 0.0001, Chi-square, Figure 1) had 0.6±2.1 (P < 0.0001, paired t-test) bleeding events (0.2±0.6 major, P < 0.0001) and 0.6±1.9 transfusions per year (P = 0.671). 14 patients had stroke before and 3 after LAAC (P = 0.008). OAC or antiplatelet therapy was used in 55% (4%) before (after) LAAC. Serum hemoglobin increased from initially 9.9±3.0 g/dL until the end of follow-up to 11.9±2.3 g/dL (P = 0.0005, Figure 2). Adverse embolic events did not differ before and after LAAC in our collective.

Conclusion: LAAC in this real world collective in patients with intolerance to OAC revealed a reduced rate in stroke and bleeding events, which translated into a rising serum hemoglobin concentration. Thus, LAAC is a safe and efficient therapy for AF patients at risk for stroke, who do not tolerate OAC.