Left Atrial Appendage Occlusion Reduced Risk of Ischemic Stroke for People with Atrial Fibrillation Compared with Oral Anticoagulation Therapy Alone

Left atrial appendage occlusion (LAAO) was superior to continued oral anticoagulation therapy (OAT) alone in reducing risk of ischemic stroke for people with nonvalvular atrial fibrillation (AF) who had a previous thrombotic event (TE) despite taking an OAT. The results of an international cohort study, published in JAMA Neurology, suggest the utility of implementing LAAO for the treatment of this population who is at high risk of ischemic stroke.

The findings result from an analysis of the international STR-OAC LAAO cohort, which consists of 21 centers with patients from LAAO registries. The analysis included a total of 433 patients with AF from this cohort who received LAAO treatment between 2010 and 2022 for TE or persistent left atrial appendage thrombi despite taking OAT. These patients were propensity score-matched with 433 patients from the control cohort with AF who continued or switched to OAT after a TE but did not receive LAAO.

• During 2-years of follow-up, 50 patients experienced an ischemic stroke.
• Ischemic stroke occurred at an annualized event rate of 2.8% per patient-year for those who received LAAO vs 8.9% per patient-year for those who received OAT alone.
• Compared with OAT alone, LAAO was associated with a lower risk of ischemic stroke (hazard ratio [HR], 0.33; 95% CI, 0.19 to 0.58; P<.001).
• 290 patients (67%) who received LAAO discontinued OAT after treatment, and 143 patients (33%) continued OAT as an adjunctive therapy.

The study authors note that randomized controlled trial data are needed to confirm the findings from this cohort study.