Background: Patients who have an ischemic stroke (IS) with oral anticoagulant (OAC) have a high recurrence rate of IS. There is insufficient data on left atrial appendage closure (LAAC) for patients with nonvalvular atrial fibrillation (NVAF) who have had an IS despite OAC.
Objectives: The objectives of this study were to compare the clinical outcomes of the patients after LAAC based on IS risk.
Methods: This study was retrospective observational study from the OCEAN-LAAC registry. NVAF patients who underwent LAAC were divided into three groups; a control group with no IS history; a group having a previous IS despite OAC; and a group having a previous IS without OAC. The coprimary endpoints were cardiovascular (CV) death and IS.
Results: We included 1418 patients (median CHA2DS2-VASc 5.0, HAS-BLED 3.0) undergoing LAAC. The previous history of IS was noted in 503 (35.4%), and 346 patients were under OAC. During the median follow-up period of 367 days, no differences in CV death rate were observed among the three groups: Previous IS despite OAC: subdistribution HR (sHR) 1.78; 95% CI: 0.87-3.64, previous IS without OAC: sHR 1.45; 95% CI: 0.59-3.55. The incidence of IS after LAAC was predominantly higher in the previous IS despite OAC group (sHR 2.62; 95% CI: 1.17-5.86; Gray’s test: P = 0.02, previous IS without OAC: sHR 1.24; 95% CI: 0.36-4.28; Gray’s test: P = 0.7).
Conclusions: The patients after LAAC who have had an IS despite OAC did not differ in CV death, but were at higher risk of IS even after LAAC.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Authors
Tadatomo Fukushima, MD
Masato Fukunaga, MD
Important Dates
Date of Release: December 22, 2025
Term of Approval/Date of CME/MOC Expiration: December 21, 2026