Emilio Osorio: Can Anticoagulation Be Safely Discontinued After Surgical Left Atrial Appendage Occlusion?
Emilio Osorio, Co-Founder of Aortic Technologies, Cardiac Surgeon at Medical University of Vienna, shared a post on LinkedIn about a recent article by Nicholas J. Goel et al., published in The Annals of Thoracic Surgery, adding:
“Surgical left atrial appendage occlusion has become an extremely important strategy for stroke prevention in patients with atrial fibrillation undergoing cardiac surgery.
As surgeons, we have the unique opportunity to close the left atrial appendage epicardially during the index operation and, when successfully performed, to exclude it completely from the bloodstream. Importantly, the devices we use do not leave any material inside the heart that is exposed to circulating blood. Therefore, no additional anticoagulation is required for the device itself.
However, one key question remains highly relevant for us in daily practice:
Can we safely discontinue long-term anticoagulation after surgical left atrial appendage occlusion?
Congratulations to Goel and colleagues from the group of Nimesh Desai for addressing this complex question in a large Medicare cohort of more than 10,000 patients undergoing concomitant surgical left atrial appendage occlusion.
Their study sends an important signal: early discontinuation of anticoagulation was associated with substantially less major bleeding, a modestly higher risk of embolic events, and no difference in the composite outcome of mortality, embolism, or major bleeding over five years.
I had the privilege of writing an invited Editorial Commentary on this study in The Annals of Thoracic Surgery together with Prof. Sigrid Sandner. In our Commentary, we discuss why these findings are highly relevant, but should not yet be interpreted as a general reason to stop anticoagulation after surgical closure.
Our main message: surgical left atrial appendage occlusion is well established, but the postoperative antithrombotic strategy still needs to be individualized. Until randomized data become available, decisions regarding anticoagulation should be guided by patient-specific thromboembolic and bleeding risk, concomitant antiplatelet therapy, and imaging-confirmed completeness of closure.
Congratulations again to the authors for an important contribution to a clinically very relevant discussion.”
Title 1: Early Discontinuation of Long-Term Anticoagulation After Surgical Left Atrial Appendage Occlusion
Authors: Nicholas J. Goel, Yu Zhao, Alexandra E. Sperry, John J. Kelly, Waseem Lutfi, John DePaolo, Lauren A. Gillinov, Chase R. Brown, Emily J. MacKay, Alexander C. Fanaroff, Nimesh D. Desai
Title 2: Anticoagulation After Surgical Left Atrial Appendage Occlusion: Still an Unanswered Question
Authors: Emilio Osorio-Jaramillo, Sigrid Sandner
Read the Full Article on The Annals of Thoracic Surgery
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