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. 2025 Sep 15:S2405-500X(25)00630-9.
doi: 10.1016/j.jacep.2025.07.021. Online ahead of print.

Left Atrial Appendage Closure for Patients With a History of Ischemic Stroke Despite Oral Anticoagulant

Tadatomo Fukushima  1 , Masato Fukunaga  2 , Akihiro Isotani  3 , Miho Nakamura  3 , Kenichi Ishizu  3 , Shinichi Shirai  3 , Masahiko Asami  4 , Mitsuru Sago  5 , Shuhei Tanaka  6 , Ryuki Chatani  7 , Daisuke Hachinohe  8 , Toru Naganuma  9 , Yohei Ohno  10 , Tomoyuki Tani  11 , Hideharu Okamatsu  12 , Yusuke Watanabe  13 , Masaki Izumo  14 , Mike Saji  15 , Shingo Mizuno  16 , Hiroshi Ueno  6 , Shunsuke Kubo  17 , Masaki Nakashima  18 , Masanori Yamamoto  19 , Kenji Ando  3 , Kentaro Hayashida  20 ; OCEAN-LAAC Investigators
Affiliations

Left Atrial Appendage Closure for Patients With a History of Ischemic Stroke Despite Oral Anticoagulant

Tadatomo Fukushima et al. JACC Clin Electrophysiol. .

Abstract

Background: Patients who have an ischemic stroke (IS) with an oral anticoagulant (OAC) have a high recurrence rate of IS. There is insufficient data on left atrial appendage closure (LAAC) for patients with nonvalvular atrial fibrillation (AF) who have had an IS despite OAC.

Objectives: The objectives of this study were to compare the clinical outcomes of the patients after LAAC based on IS risk.

Methods: This study was retrospective observational study from the OCEAN-LAAC (Optimized Catheter Valvular Intervention-Left Atrial Appendage Closure) registry. Nonvalvular AF patients who underwent LAAC were divided into 3 groups: a control group with no IS history, a group having a previous IS despite an OAC, and a group having a previous IS without OAC. The coprimary endpoints were cardiovascular (CV) death and IS.

Results: We included 1,418 patients (median CHA2DS2-VASc 5.0, HAS-BLED 3.0) undergoing LAAC. The previous history of IS was noted in 503 (35.4%), and 346 patients were under an OAC. During the median follow-up period of 367 days, no differences in CV death rate were observed among the 3 groups (previous IS despite OAC, subdistribution HR [sHR]: 1.78; 95% CI: 0.87-3.64; previous IS without OAC, sHR: 1.45; 95% CI: 0.59-3.55). The incidence of IS after LAAC was predominantly higher in the previous IS despite OAC group (sHR: 2.62; 95% CI: 1.17-5.86; Gray's test: P = 0.02; previous IS without OAC: sHR: 1.24; 95% CI: 0.36-4.28; Gray's test: P = 0.70).

Conclusions: The patients after LAAC who have had an IS despite OAC did not differ in CV death but were at higher risk of IS even after LAAC.

Keywords: WATCHMAN; ischemic stroke; left atrial appendage closure.

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Conflict of interest statement

Funding Support and Author Disclosures The OCEAN-LAAC registry, which is part of OCEAN-SHD registry, is supported by Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Medical, and Daiichi-Sankyo. Drs Fukunaga, Asami, Chatani, Hachinohe, Ueno, Kubo, Nakashima, and Yamamoto have served as clinical proctors for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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