TCT-746 Stroke Risk after Left Atrial Appendage Occlusion in Patients with Prior Intracranial Hemorrhage: A Propensity-Matched Analysis
Recommended Citation
Ramadan A, Kamel I, Doma M, Lingamsetty SS, Ahmed MS, Ismayl M, Mahmoud A, Villablanca P, Goldsweig A. TCT-746 Stroke Risk after Left Atrial Appendage Occlusion in Patients with Prior Intracranial Hemorrhage: A Propensity-Matched Analysis. J Am Coll Cardiol 2025; 86(17):B324-B325.
Document Type
Conference Proceeding
Publication Date
10-28-2025
Publication Title
J Am Coll Cardiol
Keywords
aged, anticoagulation, atrial fibrillation, bleeding, brain hemorrhage, cerebrovascular accident, cohort analysis, complication, conference abstract, controlled study, drug therapy, female, heart atrium appendage, human, left atrial appendage closure, male, prevention, propensity score, retrospective study, therapy
Abstract
Background: Patients with atrial fibrillation (AF) and prior intracranial hemorrhage (ICH) present a clinical challenge for stroke prevention. Left atrial appendage occlusion (LAAO) offers an alternative to long-term anticoagulation for the general population patients with AF and contraindications to anticoagulation, but the impact of LAAO on stroke in patients with ICH is unknown. Methods: Using the TriNetX database, we identified patients with AF and prior nontraumatic ICH who underwent LAAO (n=1530) and compared them to matched controls without LAAO (n=1530) using 1:1 propensity score matching. Outcomes assessed were freedom from (1) composite stroke (ischemic or hemorrhagic), (2) recurrent hemorrhagic stroke, and (3) ischemic stroke, over a 5-year period. Kaplan-Meier analysis and Cox proportional hazard models were used to assess time-to-event outcomes. Results: LAAO was associated with significantly lower stroke risk (Figure). Patients with LAAO had lower risks of the composite of ischemic or hemorrhagic stroke (HR 0.41; 95% CI 0.37–0.44; p<0.01; Figure 1A). Individually, recurrent hemorrhagic stroke was less frequent with LAAO (HR 0.52; 95% CI 0.46–0.58; p<0.01; Figure 1B) as was ischemic stroke (HR 0.49; 95% CI 0.43–0.54; p<0.01; Figure 1C). Stroke-free status at 5 years was higher with LAAO than without LAAO across all three endpoints. [Formula presented] Conclusion: In patients with AF and prior ICH, LAAO was associated with significantly reduced risk of both recurrent hemorrhagic and ischemic stroke. These findings support LAAO as a potent stroke prevention strategy in patients with prior ICH. Categories: STRUCTURAL: Left Atrial Appendage Exclusion
Volume
86
Issue
17
First Page
B324
Last Page
B325
