{
  "abstract": "Background/Objectives: Atrial fibrillation (AF) after intracerebral hemorrhage (ICH) creates a therapeutic conflict: withholding oral anticoagulation may increase ischemic stroke risk, whereas resumption of anticoagulation may increase recurrent ICH. Left atrial appendage occlusion (LAAO) offers a nonpharmacologic alternative, but isolated stroke or bleeding rates do not describe the overall benefit–harm balance. This focused review examines net clinical benefit (NCB) as a decision framework for LAAO after ICH and presents a secondary benchmark-adjusted analysis derived from our prior systemaatic review and meta-analysis. Methods: Thirteen endocardial LAAO cohorts with complete data for ischemic stroke, recurrent ICH, major bleeding, and all-cause death contributed to the analysis. The component event data and prespecified severity weights were carried forward from the prior meta-analysis; the external benchmark comparison, study-level benchmark-adjusted NCB synthesis, and benchmark-sensitivity analyses were not part of that report and constitute the distinct secondary analysis presented here. Results: Prespecified external benchmark rates were 8.0, 2.0, 3.0, and 6.0 events per 100 patient-years, respectively. Unweighted and severity-weighted NCB were evaluated using both pooled-rate and study-level Hartung–Knapp random-effects approaches. Study-level pooled NCB was 12.20 events per 100 patient-years (95% CI, 8.61–15.79; I2 = 96%), and weighted NCB was 14.39 (95% CI, 8.84–19.94; I2 = 94%). Additional two-component analyses using PRESTIGE-AF reference rates yielded unweighted NCB estimates of 5.65 and 2.06 events per 100 patient-years for no-OAC and DOAC comparator scenarios, respectively. Excluding all-cause mortality from the original model yielded an unweighted NCB of 8.41. These exploratory results highlight the sensitivity of NCB estimates to comparator selection and endpoint composition. Conclusions: Contemporary randomized evidence, including PRESTIGE-AF, CLOSURE-AF, and CHAMPION-AF, reinforces that benefit–harm balance is population-, comparator-, endpoint-, and time-horizon-dependent. Accordingly, these NCB estimates should be interpreted as decision-analytic and hypothesis-generating rather than causal treatment effects. ICH-specific randomized comparisons remain essential.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA",
    "Amyloidosis Center of Excellence, Department of Therapeutics, National and Kapodistrian University of Athens, 11528 Athens, Greece",
    "Department of Cardiology, University Hospital of Larissa, 41334 Larissa, Greece",
    "Medical School of Athens, National and Kapodistrian University of Athens, 11527 Athens, Greece",
    "Department of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA 19096, USA"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Christos Kourek",
      "orcid": "0000-0003-4348-2153"
    },
    {
      "affs": [
        0
      ],
      "name": "Serge Sicouri",
      "orcid": "0000-0002-1822-768X"
    },
    {
      "affs": [
        1
      ],
      "name": "Alexandros Briasoulis",
      "orcid": "0000-0002-5740-9670"
    },
    {
      "affs": [
        0
      ],
      "name": "Dimitrios E. Magouliotis",
      "orcid": "0000-0001-5417-6392"
    },
    {
      "affs": [
        2
      ],
      "name": "Andrew Xanthopoulos",
      "orcid": "0000-0002-9439-3946"
    },
    {
      "affs": [
        3
      ],
      "name": "Ioannis Paraskevaidis",
      "orcid": "0000-0002-7764-6411"
    },
    {
      "affs": [
        0,
        4
      ],
      "name": "Basel Ramlawi",
      "orcid": "0000-0002-0471-0910"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/crgmbkv4q85jr.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218612",
  "fulltext_url": null,
  "id": "crgmbkv4q85jr",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8612",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-05",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/crgmbkv4q85jr.ris",
  "sources": [
    {
      "first_seen": "2026-11-05T12:21:24Z",
      "native_id": "10.3390/jcm15218612",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8612"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Net Clinical Benefit of Left Atrial Appendage Occlusion After Intracerebral Hemorrhage in Atrial Fibrillation: A Focused Review and Benchmark-Adjusted Secondary Analysis",
  "title_text": "Net Clinical Benefit of Left Atrial Appendage Occlusion After Intracerebral Hemorrhage in Atrial Fibrillation: A Focused Review and Benchmark-Adjusted Secondary Analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T00:21:23Z",
  "url": "https://research.draconitic.com/paper/crgmbkv4q85jr",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}