%0 Journal Article %T Is Anticoagulation Warranted after Left Atrial Appendage Ligation in Patients at Risk for Stroke after Cardiac Surgery? %A Alexander P. Kossar %A Yaagnik D. Kosuri %A Samantha Nemeth %A Brigitte E. Kazzi %A Yuming Ning %A James Doolittle %A Denise McLaughlin %A Paul Kurlansky %A Isaac George %J World Journal of Cardiovascular Surgery %P 26-43 %@ 2164-3210 %D 2023 %I Scientific Research Publishing %R 10.4236/wjcs.2023.132003 %X Objectives: Left atrial appendage ligation (LAAL) may constitute alternative stroke prophylaxis in patients with atrial fibrillation (AF). Herein we describe the 30-day post discharge outcomes of cardiac surgery patients with elevated stroke risk with or without anticoagulation (AC) following epicardial LAAL. Methods: Data were reviewed for 479 consecutive adult patients who underwent epicardial LAAL from 2014-2019 (median CHA₂DS₂-VASc score = 4.0). There were 251 and 228 patients discharged with and without AC, respectively, who were followed for 30 days. Patients were matched via 1:1 Propensity Score Matching (PSM; n = 115 per group). Post-discharge outcomes included stroke, bleeding, readmission for cardiac re-intervention, mortality, and a composite endpoint comprised of the aforementioned outcomes. Results: There was no difference in post-discharge stroke incidence regardless of AC (adjusted cumulative incidence (ACI) 0.009 CI [0.001 - 0.043] with AC vs 0.009 CI [0.001 - 0.43] without AC; p = 0.826), post-discharge bleeding (ACI 0.018 CI [0.003