Left Atrial Appendage Closure for Patients with a History of Ischemic Stroke despite Oral Anticoagulant (JCEP December 2025)-Article: Left Atrial Appendage Closure for Patients with a History of Ischemic Stroke despite Oral Anticoagulant

Article: Left Atrial Appendage Closure for Patients with a History of Ischemic Stroke despite Oral Anticoagulant

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This retrospective observational study from the OCEAN-LAAC registry in Japan investigated clinical outcomes after left atrial appendage closure (LAAC) in 1,418 nonvalvular atrial fibrillation (AF) patients, with a focus on those who had prior ischemic stroke (IS) despite oral anticoagulant (OAC) therapy. Patients were divided into three groups: control (no IS history), prior IS despite OAC, and prior IS without OAC.<br /><br />Key findings showed that 35.4% had previous IS, with 24.4% experiencing IS despite OAC. Over a median follow-up of 367 days, cardiovascular (CV) death rates did not significantly differ across groups. However, the incidence of IS after LAAC was significantly higher in the prior IS despite OAC group (4.0%) compared to controls (1.6%) and those without OAC (2.5%), highlighting a persistent elevated stroke risk even after LAAC in this high-risk subset. Notably, ischemic stroke recurrence was linked to increased all-cause mortality and CV death.<br /><br />Procedural success rates were high and similar among groups, and device-related thrombosis (DRT) rates did not differ significantly. OAC discontinuation rates post-LAAC were lower in the prior IS despite OAC group, reflecting continued perceived risk; however, stroke rates did not differ between patients who continued versus discontinued OAC after LAAC within this group.<br /><br />Secondary analysis indicated fewer bleeding events in the prior IS despite OAC group. The study suggests that systemic atherosclerosis and DRT may contribute to recurrent IS post-LAAC, but these factors require further research. The findings underscore that patients with IS despite OAC remain at elevated stroke risk after LAAC, and optimal post-procedure management, including tailored OAC strategies, remains to be elucidated.<br /><br />Limitations include observational design, potential underreporting, and lack of adjustment for confounders such as atherosclerosis and device type differences. Overall, LAAC may offer stroke risk reduction benefits in high-risk AF patients, but recurrent IS remains a concern, necessitating careful patient selection and individualized anticoagulant management post-LAAC.

Keywords

left atrial appendage closure

nonvalvular atrial fibrillation

ischemic stroke

oral anticoagulant therapy

stroke recurrence

cardiovascular death

device-related thrombosis

anticoagulant discontinuation

bleeding events

stroke risk management