Left atrial appendage occlusion (LAAO) is a reasonable treatment option for patients with atrial fibrillation (AF) and a history of intracranial hemorrhage (ICH), according to a new study. The large-scale registry analysis, published in JACC: Clinical Electrophysiology, examined outcomes from 133,947 patients. Of these, 15,428 had prior ICH, a group excluded from randomized trials due to concerns about bleeding risk. Patients with a history of ICH experienced more neurological complications after LAAO compared with those without prior brain bleeds. Nevertheless, researchers found that the overall stroke and bleeding rates in this high-risk group were far lower than would be expected if they had received no treatment. Increased complications “Patients with prior ICH undergoing LAAO have increased neurologic complications,” wrote the paper’s authors, led by Moussa Mansour, MD, of Massachusetts General Hospital and Harvard Medical School in Boston. “However, overall event rates are well below those associated with similar patients not receiving OAC. LAAO seems to be a reasonable option for patients with prior ICH.” The analysis showed event rates remained low across both groups. Patients with ICH had higher risks of ischemic stroke, transient ischemic attack and recurrent brain bleeds. In contrast, those without ICH were more likely to experience non-neurologic bleeding events, particularly gastrointestinal hemorrhage, likely reflecting greater use of anticoagulant medications. “Putting the actual event rates into perspective based on the existing literature suggests that the overall rates in both groups are still relatively low; predictions based on CHA₂DS₂-VASc score for recurrent stroke without intervention would suggest LAAO therapeutic benefit in both groups,” said the paper’s authors. Mortality at one year Mortality at one year was high in both cohorts, reflecting the advanced age and medical complexity of the population, many of whom carried multiple cardiovascular risk factors. Despite this, the registry data indicated that LAAO could provide meaningful protection against stroke for patients who are not candidates for long-term anticoagulation. “After LAAO, patients with prior ICH are more likely to have stroke and ICH in-hospital and to develop ICH as well as all stroke types during follow-up,” said the paper’s authors. “However, the overall ICH and stroke rates remain low after LAAO compared with other modalities of treatment based on historical data.” Sources: Mansour M, Novack V, Freeman JV, et al. Left Atrial Appendage Occlusion in Patients With Prior Intracranial Hemorrhage. JACC Clin Electrophysiol. 2025. [Article in Press]. Image Credit: Uladzislau – stock.adobe.com