Safety and effectiveness of left atrial appendage occlusion in patients with atrial fibrillation and high bleeding risk: a cardinality-matched comparison with direct oral anticoagulation on long-term stroke and bleeding rates Article Swipe
Thomas Gilhofer
,
Victor Schweiger
,
Victoria Bokemeyer
,
Mario Gehler
,
Jonathan Michel
,
Chen Mi
,
Alessandro Candreva
,
Linn Ryberg
,
Davide Di Vece
,
Christian Templin
,
Barbara E. Stähli
,
Julia Stehli
,
Alexander Gotschy
,
Philipp Jakob
,
Frank Ruschitzka
,
Stefanie Aeschbacher
,
Philipp Krisai
,
Leo H. Bonati
,
Moa Lina Haller
,
Nicolas Rodondi
,
Jürg H. Beer
,
Peter Ammann
,
Giorgio Moschovitis
,
Elia Rigamonti
,
Stefan Osswald
,
David Conen
,
Fabian Nietlispach
,
Ronald K. Binder
,
Tobias Reichlin
,
Michael Kühne
,
Albert Markus Kasel
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.57187/s.4288
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.57187/s.4288
STUDY AIMS: Left atrial appendage occlusion (LAAO) is an accepted alternative stroke prevention strategy for patients with atrial fibrillation (AF) and contraindications to oral anticoagulation despite the lack of randomised data in this population. This study aims to compare the outcomes of LAAO and direct oral anticoagulation (DOAC) therapy in patients with high bleeding risk. METHODS: This cardinality-matched analysis comprised data from the Beat-AF and Swiss-AF cohorts (n = 3960; enrolment from 2010 to 2014 and from 2014 to 2017, respectively), along with the Zurich LAAO Registry (n = 535; patients included between 2010 and 2023). The primary endpoint was a composite of stroke, cardiovascular death or major bleeding. The individual components constituted the secondary endpoints. Time-dependent cumulative incidence curves were constructed and a competing risk analysis was included. RESULTS: After matching, 478 patients with a DOAC score ≥8 and 159 patients with previous major bleeding were compared in a 1:1 and 1:2 ratio, respectively, regarding their stroke prevention strategy (DOAC versus LAAO). After a median follow-up time of 4.9 years (interquartile range [IQR]: 2.2–6.1) in all patients with a DOAC score ≥8 and 4.4 years (IQR: 2.0–6.0) in all patients with previous major bleeding, there were no significant differences in the primary endpoint (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.67–1.14, p = 0.33 and HR: 0.79, 95% CI: 0.50–1.27, p = 0.33) and in the rates of stroke (HR: 0.74, 95% CI: 0.39–1.42, p = 0.36 and HR: 1.09, 95% CI: 0.33–3.62, p = 0.89) and cardiovascular death (HR: 0.97, 95% CI: 0.68–1.38, p = 0.85 and HR: 0.91, 95% CI: 0.50–1.64, p = 0.74). The rate of major bleedings was significantly lower in the LAAO group of both cohorts (HR: 0.55, 95% CI: 0.32–0.94, p = 0.029 and HR: 0.32, 95% CI: 0.13–0.79, p = 0.013). CONCLUSION: In this high bleeding risk population, LAAO was associated with similar effectiveness in preventing atrial fibrillation-related stroke and cardiovascular death and significantly lower rates of major bleeding compared to DOAC therapy. This strengthens the value of LAAO as an alternative stroke prevention strategy for patients at high risk of bleeding.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.57187/s.4288
- https://smw.ch/index.php/smw/article/download/4288/6398
- OA Status
- diamond
- OpenAlex ID
- https://openalex.org/W4415252465
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4415252465Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.57187/s.4288Digital Object Identifier
- Title
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Safety and effectiveness of left atrial appendage occlusion in patients with atrial fibrillation and high bleeding risk: a cardinality-matched comparison with direct oral anticoagulation on long-term stroke and bleeding ratesWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
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2025-10-15Full publication date if available
- Authors
-
Thomas Gilhofer, Victor Schweiger, Victoria Bokemeyer, Mario Gehler, Jonathan Michel, Chen Mi, Alessandro Candreva, Linn Ryberg, Davide Di Vece, Christian Templin, Barbara E. Stähli, Julia Stehli, Alexander Gotschy, Philipp Jakob, Frank Ruschitzka, Stefanie Aeschbacher, Philipp Krisai, Leo H. Bonati, Moa Lina Haller, Nicolas Rodondi, Jürg H. Beer, Peter Ammann, Giorgio Moschovitis, Elia Rigamonti, Stefan Osswald, David Conen, Fabian Nietlispach, Ronald K. Binder, Tobias Reichlin, Michael Kühne, Albert Markus KaselList of authors in order
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https://doi.org/10.57187/s.4288Publisher landing page
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https://smw.ch/index.php/smw/article/download/4288/6398Direct link to full text PDF
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diamondOpen access status per OpenAlex
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https://smw.ch/index.php/smw/article/download/4288/6398Direct OA link when available
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0Total citation count in OpenAlex
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