Background: Surgical left atrial appendage amputation or closure (LAAA/C) is one of the cardiogenic ischemic stroke prevention treatments. However, long-term outcomes in patients with and without anticoagulation after surgical LAAA/C have not been systematically investigated.

Methods: A total of 414 patients who underwent surgical LAAA/C between January 2010 and December 2019 were included. The cumulative incidence rates of cardiovascular death, stroke, including ischemic and hemorrhagic stroke, and major bleeding were compared to evaluate the clinical impact in patients with and without anticoagulation therapy at discharge.

Results: The median follow-up period of this study was 1583 (693-2823) days. A total of 88 (21.3%) patients without anticoagulation had less persistent atrial fibrillation [52 (59.1%) versus 250 (76.7%), p<0.001] than those with. They also had a higher prevalence of treatment with aspirin [80 (90.9%) versus 242 (74.2%), p<0.001]. Patients without anticoagulation experienced fewer major bleeding events (HR: 0.476; 95% CI: 0.227-0.998, p=0.045). While cardiovascular death and stroke were not significantly different between patients with and without anticoagulation (HR: 1.855; 95% CI: 0.684-5.025, p=0.217, and HR: 0.841; 95% CI: 0.178-3.968, p=0.827, respectively).

Conclusions: The current study demonstrates that patients without anticoagulation after surgical LAAA/C are at lower risk of future major bleeding.

To be updated