# Patients with Gastrointestinal Bleeding and Atrial Fibrillation: Potential Ideal Target for Epicardial Appendage Occlusion

## TL;DR

Epicardial appendage occlusion without antithrombotic therapy reduces rebleeding and stroke risk in patients with atrial fibrillation and gastrointestinal bleeding.

## Contribution

This study is the first to report on stroke prevention and rebleeding outcomes using epicardial appendage occlusion without antithrombotic therapy in this patient group.

## Key findings

- Bleeding rate was 0.91 events per year with an 83% relative risk reduction.
- Stroke relative risk was 0.91 events per year with an 81% relative risk reduction.
- Standalone epicardial appendage occlusion without antithrombotic therapy is safe and effective in reducing rebleeding and stroke risk.

## Abstract

Background: Gastrointestinal bleeding in patients with atrial fibrillation is an indication for left appendage occlusion. All endovascular devices mandate antithrombotic therapies: rebleeding risk remains an issue. To date, there are no reports on gastrointestinal rebleeding and stroke prevention by left appendage occlusion without any antithrombotic therapy in this category of patients. Methods: A total of 129 patients (male 85, mean age 76.6 ± 7.1, CHA2DS2Vasc 3.8 ± 1.5, HASBLED 3.3 ± 1.0; upper GI bleeding 10%, lower GI bleeding 86%, obscure occult 4.6%, on NOACS full dose 77.5%, NOACs reduced dose 13.1%, on anti-vitamin K 9.3%) with atrial fibrillation and history of repetitive gastrointestinal bleeding from ten centers underwent standalone thoracoscopic epicardial appendage closure without antithrombotic therapy for the entire follow up. Results: The observed bleeding rate was 0.91 events per year, equivalent to a relative risk of RR = 0.17 (p = 0.02) and a relative risk reduction (RRR) of 83%. The observed relative risk of stroke was 0.91 events per year, with a relative risk of RR = 0.19 (p = 0.03) and a relative risk reduction (RRR) of 81%. Conclusion: Standalone epicardial appendage occlusion without antithrombotic therapy in patients with repetitive gastrointestinal bleeding is safe and promising when rebleeding and stroke risk reduction need to be optimized.