Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Left atrial appendage occlusion (LAAO) offers cardioembolic protection for atrial fibrillation (AF) patients unable to use oral anticoagulation therapy (OAT).
• Patients experiencing thrombotic events while on OAT have a high risk of recurrence and may benefit from LAAO.

Purpose of the Study:

• To evaluate the efficacy of LAAO in AF patients with a thrombotic event on OAT.
• To compare LAAO outcomes in this group against LAAO in OAT-contraindicated patients and historical data.

Main Methods:

• The STR-OAC LAAO collaboration included patients with thrombotic events on OAT who underwent LAAO.
• Propensity score matching was used to compare this cohort with the EWOLUTION registry (OAT-contraindicated patients).
• The primary outcome was ischemic stroke, with comparisons to historical data without OAT.

Main Results:

• No significant difference in ischemic stroke rates between STR-OAC LAAO and EWOLUTION cohorts (2.5% vs 1.9%).
• STR-OAC LAAO patients had higher thromboembolic risk but lower bleeding risk compared to EWOLUTION.
• Relative risk reductions for ischemic stroke were substantial compared to historical data without OAT (70% for STR-OAC LAAO, 78% for EWOLUTION).

Conclusions:

• LAAO in patients with a thrombotic event on OAT shows stroke rates comparable to the OAT-contraindicated population.
• Risk profiles differ, with higher thromboembolic and lower bleeding risks in the STR-OAC LAAO group.
• LAAO is a potential consideration for patients experiencing ischemic events despite OAT, pending randomized trial data.