DGK Herztage 2025. Clin Res Cardiol (2025). https://doi.org/10.1007/s00392-025-02737-x
1Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland
Background
Intracerebral hemorrhage (ICH) is a serious complication in patients with atrial fibrillation (AF) requiring oral anticoagulation (OAC). Management after ICH is challenging due to bleeding risk. Left atrial appendage occlusion (LAAO) has emerged as an alternative, but outcome data in this population are limited.
Methods
The global TriNetX platform was used to identify patients with AF who experienced ICH and subsequently received either continuation of OAC or underwent LAAO. Propensity score matching was performed after adjustment for clinical confounders. The primary endpoint was all-cause mortality; secondary endpoints included stroke/TIA, transfusion, and myocardial infarction.
Results
A total of 3,065 patients with LAAO and 50,834 with OAC were identified. After propensity score matching based on key clinical parameters—including age, sex, ischemic heart disease, arterial hypertension, hypertensive heart disease, chronic kidney disease, heart failure, diabetes, peripheral artery disease, previous stroke and TIA—two well-balanced cohorts (each n = 3,064) were established. The median follow-up was 1.75 years. All-cause mortality was significantly lower in the LAAO group compared to OAC (HR 0.49, 95% CI 0.44–0.55; p < 0.0001). Secondary endpoint analysis showed reduced risks for stroke/TIA (HR 0.84, 95% CI 0.77–0.92; p = 0.0003), transfusion (HR 0.71, 95% CI 0.58–0.85; p = 0.0003), and myocardial infarction (HR 0.84, 95% CI 0.72–0.97; p = 0.02) in the LAAO group. Rates of acute or emergency rehospitalization were comparable between groups (HR 0.94, 95% CI 0.87–1.01; p = 0.09).
Conclusion
In patients with atrial fibrillation and a history of intracerebral hemorrhage, LAAO was associated with lower all-cause mortality, fewer arterial ischemic events, and reduced major bleeding compared to continued OAC. These findings highlight the potential of LAAO as a therapeutic alternative in this high-risk population, warranting confirmation in prospective randomized trials.