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Peer-reviewedCC BY 4.0Europace

Beyond anticoagulation: defining the role of left atrial appendage closure in stroke prevention for atrial fibrillation

  • A John Camm1
  1. 1Cardiovascular and Genomics Research Institute, School of Health & Medical Sciences, City St George’s University of London, Tooting Campus, Cranmer Terrace, London SW17 0RE, UK
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Abstract

Oral anticoagulation has a very strong evidence base for stroke prevention in patients with atrial fibrillation (AF) at elevated thromboembolic risk. Direct oral anticoagulants have improved the safety and convenience of treatment, yet important limitations remain, including residual ischaemic stroke, major bleeding, treatment discontinuation, and patient refusal. Left atrial appendage closure (LAAC) offers an alternative strategy for selected patients by excluding the principal anatomical source of AF-related cardiac thrombi. However, the appropriate role of LAAC remains controversial, particularly in patients who can and do tolerate anticoagulation. This viewpoint argues for a more individualized approach that distinguishes absolute contraindications from modifiable bleeding risks, treatment refusal or non-persistence, and stroke occurring despite adequate anticoagulation.

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Cite

BibTeXRIS
BibTeX
@article{camm2026beyond,
  title = {{Beyond anticoagulation: defining the role of left atrial appendage closure in stroke prevention for atrial fibrillation}},
  author = {A John Camm},
  journal = {Europace},
  year = {2026},
  month = nov,
  doi = {10.1093/europace/euag296},
  url = {https://doi.org/10.1093/europace/euag296},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Beyond anticoagulation: defining the role of left atrial appendage closure in stroke prevention for atrial fibrillation
AU  - A John Camm
PY  - 2026
DA  - 2026/11/06
JO  - Europace
DO  - 10.1093/europace/euag296
UR  - https://doi.org/10.1093/europace/euag296
AB  - Oral anticoagulation has a very strong evidence base for stroke prevention in patients with atrial fibrillation (AF) at elevated thromboembolic risk. Direct oral anticoagulants have improved the safety and convenience of treatment, yet important limitations remain, including residual ischaemic stroke, major bleeding, treatment discontinuation, and patient refusal. Left atrial appendage closure (LAAC) offers an alternative strategy for selected patients by excluding the principal anatomical source of AF-related cardiac thrombi. However, the appropriate role of LAAC remains controversial, particularly in patients who can and do tolerate anticoagulation. This viewpoint argues for a more individualized approach that distinguishes absolute contraindications from modifiable bleeding risks, treatment refusal or non-persistence, and stroke occurring despite adequate anticoagulation.
SN  - 1099-5129
SN  - 1532-2092
ER  -