TCT-746 Stroke Risk after Left Atrial Appendage Occlusion in Patients with Prior Intracranial Hemorrhage: A Propensity-Matched Analysis

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

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

Find It @ Sladen

Share

COinS