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Related Experiment Video

Updated: Jan 17, 2026

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Left Atrial Appendage Closure in Patients Refusing Oral Anticoagulation: The LAAC-REFUSAL Study.

Roberto Galea1, Tommaso Bini1, Kasper Korsholm2

  • 1Department of Cardiology Inselspital, Bern University Hospital, University of Bern Switzerland.

Journal of the American Heart Association
|September 25, 2025
PubMed
Summary
This summary is machine-generated.

Left atrial appendage closure (LAAC) is a safe and feasible option for patients with atrial fibrillation refusing oral anticoagulation (OAC). This procedure demonstrated promising reduced ischemic outcomes at three years compared to predicted risks.

Keywords:
adherenceatrial fibrillationintoleranceleft atrial appendage closurenon‐complianceoral anticoagulation refusal

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Left atrial appendage closure (LAAC) is an alternative for patients with atrial fibrillation (AF) who cannot tolerate oral anticoagulation (OAC).
  • The efficacy and safety of LAAC in patients refusing OAC remain largely uncharacterized.

Purpose of the Study:

  • To assess the efficacy and safety of LAAC in patients with AF who refuse OAC.
  • To compare outcomes in OAC-refusing patients undergoing LAAC with those undergoing LAAC for established indications.

Main Methods:

  • A multicenter retrospective analysis of consecutive AF patients undergoing percutaneous LAAC (2009-2022).
  • Patients were categorized into an OAC refusal group and a control group (LAAC for standard indications).
  • Primary endpoint: composite of cardiovascular death, stroke, or systemic embolism; secondary endpoints: technical success and procedural complications.

Main Results:

  • 119 patients (4.5%) underwent LAAC due to OAC refusal; 238 controls were identified.
  • The OAC refusal group comprised younger, lower-risk patients.
  • At 3 years, the primary endpoint was significantly lower in the refusal group (4.2% vs. 17.2%; aHR: 0.37; P=0.048).
  • Technical success and complication rates were similar between groups.
  • In the refusal group, annual rates of thromboembolic events (2.3%) and major bleeding (1.9%) showed significant risk reductions compared to predicted scores.

Conclusions:

  • OAC refusal is an infrequent indication for LAAC but represents a feasible and safe procedural option.
  • LAAC demonstrated promising ischemic outcome rates at 3 years in OAC-refusing patients.
  • Further research is warranted to elucidate the comparative benefits of LAAC versus OAC in this specific patient subgroup.