Incidence, Predictors, Management, and Clinical Impact of Major Bleeding Following Left Atrial Appendage Occlusion

What are the implications of major bleeding after left atrial appendage occlusion in the Amulet IDE trial?In this study, major bleeding occurred primarily within the first 6 months, driven by periprocedural factors and intensive antithrombotic therapy, then declined as therapy is reduced. Predictors are patient-specific—older age, female sex, diabetes, prior bleeding, and kidney disease, and major bleeding was linked to higher rates of stroke and mortality.These results highlight the need for individualized bleeding-risk assessment, careful antithrombotic management, optimized procedural safety, and vigilant postimplant monitoring, as early bleeding is common and associated with worse outcomes.

Corresponding Author: Boris Schmidt, MD, Cardioangiologisches Centrum Bethanien, Wilhelm-Epstein Strasse 4, 60431 Frankfurt, Germany (b.schmidt@ccb.de).

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