TITLE:
Is Anticoagulation Warranted after Left Atrial Appendage Ligation in Patients at Risk for Stroke after Cardiac Surgery?
AUTHORS:
Alexander P. Kossar, Yaagnik D. Kosuri, Samantha Nemeth, Brigitte E. Kazzi, Yuming Ning, James Doolittle, Denise McLaughlin, Paul Kurlansky, Isaac George
KEYWORDS:
Arrhythmias, Minimally Invasive Surgery, Perioperative Care
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.13 No.2,
February
28,
2023
ABSTRACT: Objectives: Left atrial appendage ligation (LAAL) may constitute
alternative stroke prophylaxis in patients with atrial fibrillation (AF).
Herein we describe the 30-day post discharge outcomes of cardiac surgery patients with elevated
stroke risk with or without anticoagulation (AC) following epicardial LAAL. Methods: Data were reviewed for 479 consecutive adult patients who underwent
epicardial LAAL from 2014-2019 (median CHA2DS2-VASc score
= 4.0). There were 251 and 228 patients
discharged with and without AC, respectively, who were followed for 30
days. Patients were matched via 1:1 Propensity Score Matching (PSM; n = 115 per
group). Post-discharge outcomes included
stroke, bleeding, readmission for cardiac re-intervention, mortality,
and a composite endpoint comprised of the aforementioned outcomes. Results: There
was no difference in post-discharge stroke incidence regardless of AC (adjusted
cumulative incidence (ACI) 0.009 CI [0.001 - 0.043] with AC vs 0.009 CI [0.001 - 0.43] without AC; p = 0.826), post-discharge bleeding (ACI 0.018 CI [0.003 - 0.057] with AC vs 0.009 CI [0.001 - 0.046] without AC; p = 0.738),
readmission for cardiac re-intervention (ACI 0.009 CI [0.009 - 0.009] with AC vs 0 CI [NA] without AC; p = 0.340,
post-discharge mortality (ACI 0 CI NA with AC vs 0.009 CI [0.001 - 0.046] without AC; p = 0.123, or in the composite outcome (ACI 0.026 CI [0.007 - 0.069] with AC vs 0.027 CI [0.007 - 0.071] without AC; p = 0.824. Conclusion: Cessation of AC in patients with elevated stroke risk following epicardial
LAAL during cardiac surgery does not affect stroke rate, mortality, or
bleeding incidence up to 30 days post-discharge in this preliminary analysis.