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Updated: Dec 28, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Closure in Patients With Intracranial Hemorrhage and Nonvalvular Atrial Fibrillation
Muhammad Ajmal1, Hursh Naik2, Abraham Kocheril3
1University of Arizona, Tucson, Arizona.
Insights
Short-term anticoagulation after left atrial appendage (LAA) closure appears safe and effective for patients with prior intracranial hemorrhage. This approach helps prevent device-related thrombus without increasing complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Left atrial appendage (LAA) closure is an alternative for patients with contraindications to anticoagulation.
- Anticoagulation is typically recommended post-LAA closure to mitigate device-related thrombus.
- Patients with a history of intracranial hemorrhage (ICH) present a unique challenge for post-procedural antithrombotic therapy.
Purpose of the Study:
- To evaluate the safety and efficacy of short-term anticoagulation following LAA closure.
- To assess outcomes in patients with a history of ICH undergoing LAA closure.
Main Methods:
- Retrospective observational study at a single center.
- Analysis of baseline characteristics, perioperative, and postoperative complications.
- Follow-up of patients with Watchman device implantation for a mean of 27 months.
Main Results:
- 16 patients with a history of ICH underwent Watchman device implantation.
- Patients received a regimen of aspirin and oral anticoagulant for 45 days, followed by dual antiplatelet therapy, then aspirin indefinitely.
- No perioperative or postoperative complications were observed.
Conclusions:
- Short-term antithrombotic therapy appears safe and effective in selected patients with previous ICH after LAA closure.
- This strategy may help prevent device-related thrombus in high-risk patients.
- Further investigation in larger cohorts is warranted.
Background:
Left atrial appendage (LAA) closure is primarily performed in patients who have contraindications to anticoagulants. However, anticoagulants are recommended for the first few weeks after LAA closure to prevent the device related thrombus. Purpose of this study was to evaluate if short term use of anticoagulant is safe and effective after LAA closure in patients with a history of intracranial hemorrhage.
Methods:
It is a retrospective observational study done at a single center. Baseline characteristics, perioperative, and postoperative complications of patients with a history of intracranial hemorrhage and Watchman device implant were analyzed, and patients were followed for a mean follow-up of 27 months.
Results:
LAA closure was performed in 16 patients using the Watchman device (Boston Scientific, MA). Mean age was 74.6 ± 5.8 years, median CHA2DS2-VASc score was 4.5 (interquartile range of 3), median HAS-BLED score was 4 (interquartile range of 1). Patients received aspirin 81 mg with oral anticoagulant for 45 days, dual antiplatelet therapy for 4.5 months, and thereafter aspirin indefinitely. No perioperative and postoperative complications were noted.
Conclusion:
Based on our single center experience, we conclude that antithrombotic drugs in the short term appear safe and effective in selected patients after LAA closure in patients with previous intracranial hemorrhage.
