This Week in Cardiology Mar 27 2026 This Week in Cardiology
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Mar 27, 2026 Discussion of early aortic valve replacement trials and long-term follow up. Analysis of left atrial appendage occlusion bleeding risks and timing. Preview of major cardiology meeting trials, including high-risk PCI device studies, AF ablation comparisons, sham-controlled CTO interventions, and spironolactone research in heart failure.
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Front Loaded Bleeding Risk After LAA Occlusion
- Major bleeding after LAA occlusion was common and front-loaded with annualized rate ≈20.5% in first 6 months then ~3.9%/yr thereafter.
- AMULET IDE pooled analysis (n≈1,800, mean age 76, CHA2DS2-VASc 4.8) found 57% GI bleeds and 47% of major bleeds occurred on no antithrombotic therapy.
Patient Factors Drive Bleeding After Appendage Closure
- Bleeding risk after LAA occlusion is driven more by patient factors than device or postprocedural antithrombotic regimen.
- Predictors included older age, female sex, diabetes, prior bleeding, and CKD; device type and discharge regimen did not predict bleeds.
Trial LAA Occlusion Versus No Antithrombotic Is Needed
- Design a randomized trial comparing LAA occlusion versus no antithrombotic therapy in older, high-bleeding-risk patients to test net benefit.
- Mandrola suggests such a trial could be stopped early for harm because procedural bleeding is high upfront.