Percutaneous Left Atrial Appendage Closure in Patients With Cardioembolic Stroke Despite Oral Anticoagulant Therapy: A Multicentre Cohort Study

Background Left atrial appendage closure (LAAC) may be used in atrial fibrillation patients with previous cardioembolic stroke (CS) despite adequate oral anticoagulation (OAC). The aim of this study was to evaluate the safety and efficacy of the hybrid strategy LAAC and OAC in patients with OAC failure. Methods In this multicentre study, patients with an ascertained CS while receiving adequate OAC were divided according to the treatment strategy after the index event (LAAC vs medical therapy [MT] group). Other potential embolic sources were excluded and all patients continued OAC after the index event. The primary end point was a composite of all-cause death, CS, and major bleeding. Results Among the 109 patients included in the study, 44 (40%) formed the LAAC group and 65 (60%) the MT group. At the median follow-up of 48 (interquartile range, 14) months, the LAAC group reported a lower rate of the primary end point (hazard ratio, 0.398; 95% confidence interval, 0.201-0.781; P = 0.008) and CS recurrence (hazard ratio, 0.273; 95% confidence interval, 0.060-0.852; P = 0.041). C ongestive Heart Failure, H ypertension, A ge (≥75 years), D iabetes, S troke/Transient Ischemic Attack, V ascular Disease, A ge (65-74 years), S ex (Female; CHA2DS2-VASc), NIH S troke S cale (NIHSS), and acute reperfusion therapy predicted the primary end point whereas CHA2DS2-VASc and NIHSS predicted CS recurrence. Results were confirmed in a propensity score-matching analysis. The calculated annualized rate of CS was 2.0 per 100 patient-years in the LAAC group and 7.8 per 100 patient-years in the MT group. Conclusions In patients with CS due to OAC failure, the hybrid strategy LAAC and OAC was associated with better long-term outcomes compared with OAC alone.