Left atrial appendage occlusion versus antithrombotic therapy in nonvalvular AF with ASCVD and prior embolism

Abstract

Managing nonvalvular atrial fibrillation (NVAF) in patients with atherosclerotic cardiovascular disease (ASCVD) and prior embolism is challenging. This retrospective study evaluated long-term outcomes of left atrial appendage occlusion (LAAO) compared with oral anticoagulation (OAC) and antiplatelet therapy (APT) in primary (n = 647) and external validation (n = 570) cohorts. The primary composite outcome included recurrent ischemic stroke or systemic embolism, major bleeding, and all-cause mortality. After inverse probability of treatment weighting (IPTW), risks of the primary outcome, major bleeding, and mortality for LAAO were comparable with or lower than those of OAC and APT. For recurrent embolism, competing-risk analyses showed both OAC (SHR = 3.578, p = 0.003) and APT (SHR = 2.494, p = 0.040) carried a higher risk than LAAO. Results were consistent in the external validation cohort. These findings suggest LAAO may be a reasonable option for this high-risk population, offering a lower risk of recurrent embolism and comparable risk of major bleeding relative to pharmacological therapies.

Left Atrial Appendage Occlusion Device Infection: A Rare Case Report and Literature Review
Abhishek Vadher, Rakesh Devireddy, Kesava Manikanta Achuta +2
Cureus16 Oct 2026Peer-reviewedCC BYFull textGeneral medicineEurope PMC
Temporal Trends and Demographic Disparities in Percutaneous Left Atrial Appendage Occlusion Utilization in the United States, 2016-2022
B. Shaun, M. R. Movahed, M. Hashemzadeh +1
medRxiv12 Oct 2026PreprintAll rights reservedFull textCardiovascular medicinemedRxiv
Embolization of a fluoropolymer-coated left atrial appendage occlusion device to the infrarenal aorta presenting with acute neurologic symptoms: A case report.
Tate Barney, Jacob Weaver, Nathaniel Dusini +1
HeartRhythm case reports4 Aug 2026Peer-reviewedCC BY-NC-NDFull textCardiovascular medicineEurope PMC
Left Atrial Appendage Occlusion with the Watchman FLX Device: A Single-Centre Retrospective Analysis of Procedural and One-Year Clinical Outcomes
Wasim Allakkis, Mostafa Salem, Mohamed Salem +6
Medical sciences (Basel, Switzerland)1 Oct 2026Peer-reviewedCC BYFull textGeneral medicineEurope PMC
Suture-Mediated Vascular Closure Improves Same-Day Discharge in Atrial Fibrillation Ablation and Left Atrial Appendage Occlusion
Mark J. Shen, Shal T. Shen, Hannah Serrano
JACC Case Reports16 Sep 2026Peer-reviewedCC BY 4.0Full textCardiovascular medicinePMC

Cite

BibTeX RIS

BibTeX

@article{lu2026left,
  title = {{Left atrial appendage occlusion versus antithrombotic therapy in nonvalvular AF with ASCVD and prior embolism}},
  author = {Chenlin Lu and Si Sun and Hao Liu and Lin Chen and Qingtao Ni and Yin Yuan and Jingcheng Chen and Chuanmeng Zhang and Zhongbao Ruan and Xiangwei Ding},
  journal = {iScience},
  year = {2026},
  month = oct,
  doi = {10.1016/j.isci.2026.118036},
  url = {https://www.cell.com/iscience/fulltext/S2589-0042(26)03419-X},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Left atrial appendage occlusion versus antithrombotic therapy in nonvalvular AF with ASCVD and prior embolism
AU  - Chenlin Lu
AU  - Si Sun
AU  - Hao Liu
AU  - Lin Chen
AU  - Qingtao Ni
AU  - Yin Yuan
AU  - Jingcheng Chen
AU  - Chuanmeng Zhang
AU  - Zhongbao Ruan
AU  - Xiangwei Ding
PY  - 2026
DA  - 2026/10/27
JO  - iScience
DO  - 10.1016/j.isci.2026.118036
UR  - https://www.cell.com/iscience/fulltext/S2589-0042(26)03419-X
AB  - Managing nonvalvular atrial fibrillation (NVAF) in patients with atherosclerotic cardiovascular disease (ASCVD) and prior embolism is challenging. This retrospective study evaluated long-term outcomes of left atrial appendage occlusion (LAAO) compared with oral anticoagulation (OAC) and antiplatelet therapy (APT) in primary (n = 647) and external validation (n = 570) cohorts. The primary composite outcome included recurrent ischemic stroke or systemic embolism, major bleeding, and all-cause mortality. After inverse probability of treatment weighting (IPTW), risks of the primary outcome, major bleeding, and mortality for LAAO were comparable with or lower than those of OAC and APT. For recurrent embolism, competing-risk analyses showed both OAC (SHR = 3.578, p = 0.003) and APT (SHR = 2.494, p = 0.040) carried a higher risk than LAAO. Results were consistent in the external validation cohort. These findings suggest LAAO may be a reasonable option for this high-risk population, offering a lower risk of recurrent embolism and comparable risk of major bleeding relative to pharmacological therapies.
SN  - 2589-0042
ER  -

Abstract

Related

Cite