Factors influencing device-related thrombosis and prognosis after left atrial appendage closure in patients with non-valvular atrial fibrillation

Kou Hanli; Tang Xizhi; Niu Xiaoqi; Xu Xiang; Liu Feng; Wan Chen; Li Huakang

doi:10.11986/j.issn.1673-873X.2025.11.10

Abstract：Objective To investigate factors associated with device-related thrombosis(DRT)after left atrial appendage clo-sure(LAAC)in patients with non-valvular atrial fibrillation(NVAF)and to analyze the relationship between DRT and prognosis.Methods From August 1,2014 to July 31,2024,a consecutive cohort of 1,581 NVAF patients who were hos-pitalized in the Department of Cardiology at the First Affiliated Hospital of Army Medical University and underwent LAAC was enrolled.Patients were assigned according to the presence or absence of postoperative DRT into a DRT group(n=40)and a non-DRT group(n=1,541).Gender,age,combined underlying diseases,laboratory results,transthoracic echocar-diography(TTE),and transesophageal echocardiography(TEE)findings were collected.Patients were followed for ische-mic stroke,bleeding,DRT,heart-failure re-hospitalization,and cardiogenic death;factors associated with DRT after LAAC and the relationship between DRT and clinical outcomes were analyzed.Results Compared with the non-DRT group,pa-tients in the DRT group were older,had higher D-dimer(D-D)levels,and lower left ventricular ejection fraction(LVEF);the differences were statistically significant(P＜0.05).Logistic regression analysis indicated that decreased LVEF was a risk factor for DRT formation(P＜0.05).All patients completed at least 6 months of follow-up.During follow-up,there were 3 strokes(7.50％)and 3 heart-failure re-hospitalizations(7.50％)in the DRT group;there were 15 major bleeding e-vents(0.97％),15 strokes(0.97％),56 heart-failure re-hospitalizations(3.64％),and 21 cardiogenic deaths(1.56％)in the non-DRT group.The incidence of stroke was significantly higher in the DRT group than in the non-DRT group(P=0.009).Kaplan-Meier survival analysis showed that DRT formation was closely associated with stroke occurrence(HR 95％CI:94.44[6.514-1,369.000],P＜0.001).Conclusion Reduced LVEF is a risk factor for DRT after LAAC,and the occurrence of DRT increases the risk of stroke.