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  • Reply to Sex Differences in the Clinical Outcomes After Left Atrial Appendage: A Systematic Review and Meta-Analysis

    We congratulate Abusnina et al.  on their systematic review and meta-analysis evaluating sex differences in the outcomes of patients undergoing percutaneous left atrial appendage occlusion (LAAO) in the prevention of stroke. Their pooled data from retrospective and prospective observational studies indicate that female sex is associated with a higher risk of adverse periprocedural safety outcomes, including pericardial effusion/cardiac tamponade (relative risk [RR]: 1.98; 95% confidence interval [CI]: 1.15–3.43; P = 0.01), in-hospital major bleeding (RR: 1.93; 95% CI 1.40–2.67; P < 0.0001) and in-hospital all-cause mortality (RR: 2.18; 95% CI: 1.46–3.26; P = 0.0001). These findings are supported by previous literature, which has identified female sex to be a risk factor for adverse periprocedural outcomes following catheter-based interventions  . The periprocedural risk associated with percutaneous LAAO was a key reason for guidelines suggesting to limit its use to the subgroup of patients with atrial fibrillation and increased risk of stroke who have contraindications to long-term anticoagulation  .

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