Arrhythmias & electrophysiology
Outcomes of left atrial appendage closure vs oral anticoagulation after catheter ablation among patients with higher and lower stroke risk: A subanalysis of the OPTION clinical trial
Authors' conclusion
After ablation of atrial fibrillation, the rates of cardiovascular events are low among individuals with a CHA2DS2-VASc score of ≤3 who were treated with either LAAC or OAC, and their annual risk of ischemic stroke is ≤0.3% with either treatment. Bleeding risk with OAC is similar for patients with high and low CHA2DS2-VASc and significantly lower with LAAC for both groups.
Study context
- Population
- Patients after atrial fibrillation ablationpatients aged 70 ± 8 years · CHA2DS2-VASc ≥4 738 · CHA2DS2-VASc ≤3 862
- Participants
- 1,600 patients
- Comparison
- Left atrial appendage closure (LAAC) vs oral anticoagulation (OAC) after catheter ablation, by CHA2DS2-VASc score of ≥4 vs ≤3
- Outcome
- Composite of:
- Death
- Stroke
- Systemic embolism (primary efficacy endpoint)
- Follow-up
- 3 years
Methodological detailsstratified by CHA2DS2-VASc score of ≥4 vs ≤3
- Stratified by CHA2DS2-VASc score of ≥4 vs ≤3
Main finding
As reported in the abstract
CHA2DS2-VASc ≥4
CHA2DS2-VASc ≤3
Further findings
Annual risk of ischemic stroke, CHA2DS2-VASc ≤3
- Annual risk of ischemic stroke, CHA2DS2-VASc ≤3: P = .19
Safety
Nonprocedural major or clinically relevant nonmajor bleeding (primary safety endpoint) · 3 years
CHA2DS2-VASc ≥4
CHA2DS2-VASc ≤3
- Nonprocedural major or clinically relevant nonmajor bleeding (primary safety endpoint): CHA2DS2-VASc ≥4: P < .01
- Nonprocedural major or clinically relevant nonmajor bleeding (primary safety endpoint): CHA2DS2-VASc ≤3: P < .01
Nonprocedural major or clinically relevant nonmajor bleeding (primary safety endpoint) · 3 years
- Bleeding more frequent with OAC
Original publication
Summarised from the published abstract; every number is checked against it