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Percutaneous Left Atrial Appendage Closure in Patients With Cardioembolic Stroke Despite Oral Anticoagulant Therapy:

Alberto Preda1, Claudio Montalto2, Luigi De Luca3

  • 1De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, Italy.

The Canadian Journal of Cardiology
|January 25, 2026
PubMed

Insights

Left atrial appendage closure (LAAC) combined with oral anticoagulation (OAC) offers better outcomes for atrial fibrillation patients experiencing cardioembolic stroke (CS) despite OAC. This hybrid strategy significantly reduces stroke recurrence compared to OAC alone.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Stroke Medicine

Background:

  • Atrial fibrillation (AF) patients with prior cardioembolic stroke (CS) despite adequate oral anticoagulation (OAC) present a clinical challenge.
  • Left atrial appendage closure (LAAC) is a potential intervention for these high-risk individuals.

Purpose of the Study:

  • To evaluate the safety and efficacy of a hybrid strategy combining LAAC and continued OAC in patients with OAC failure.
  • To compare outcomes of this hybrid strategy against medical therapy (MT) alone in patients with CS despite adequate OAC.

Main Methods:

  • A multicenter study comparing patients who underwent LAAC plus OAC versus MT alone after an index CS event while on adequate OAC.
  • Exclusion of other embolic sources and continuation of OAC for all participants.
  • Primary endpoint: composite of all-cause death, CS, and major bleeding.

Main Results:

  • The LAAC group (44 patients) showed a significantly lower rate of the primary endpoint (HR 0.398, p=0.008) and CS recurrence (HR 0.273, p=0.041) compared to the MT group (65 patients) at 48 months follow-up.
  • Annualized CS rate was 2.0 per 100 patient-years in the LAAC group versus 7.8 per 100 patient-years in the MT group.
  • CHA2DS2VA, NIHSS, and acute reperfusion therapy predicted the primary endpoint; CHA2DS2VA and NIHSS predicted CS recurrence. Propensity-score matching confirmed results.

Conclusions:

  • The hybrid strategy of LAAC plus OAC is associated with improved long-term outcomes in patients experiencing CS due to OAC failure.
  • This approach offers a superior alternative to OAC monotherapy for selected AF patients with recurrent stroke.
  • LAAC combined with OAC demonstrates significant potential in preventing recurrent cardioembolic events.
Abstract

Keywords:
Cardioembolic strokeatrial fibrillationleft atrial appendage closureoral anticoagulation failurestroke recurrence

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