Epistaxis Risk in Patients Treated With Left Atrial Appendage Occlusion Versus Oral Anticoagulation

Anticoagulants (AC) are associated with epistaxis in atrial fibrillation (AF) patients. Left atrial appendage occlusion (LAAO) is a treatment that allows AF patients to stop AC. The aim of this study is to evaluate the risk of developing epistaxis following LAAO versus direct oral anticoagulants (DOAC) and warfarin. This study uses the TriNetX database as well as institutional records. The TriNetX database was searched for AF patients on a DOAC, warfarin, or treated with LAAO. Epistaxis odds ratios were compared 1 day-6 months and 6 months-3 years following initiation of DOAC, warfarin, or LAAO. Records of LAAO patients at our institution were also reviewed. The TriNetX query returned 1,185,862 patients. On TriNetX, LAAO patients had significantly higher odds of epistaxis likely due to antiplatelet therapy from 1 day-6 months compared to warfarin patients with DOAC patients (p