Key result
Left atrial appendage occlusion patient selection in high-risk atrial fibrillation can be optimized using a multidisciplinary framework integrating clinical risk scores and neuroimaging.
Why the study?
In patients with AF not candidates for long-term anticoagulation, optimal patient selection and post-LAAO antithrombotic management remain uncertain because existing bleeding risk scores inadequately capture intracerebral hemorrhage risk.
Supports multidisciplinary input for high-risk AF decisions; extends risk scores with neuroimaging and hemorrhage phenotype.
Patients with atrial fibrillation (AF) who are not candidates for long-term anticoagulation present a complex therapeutic dilemma due to competing risks of cardioembolic stroke and intracerebral hemorrhage (ICH). This challenge is particularly pronounced in neurologically vulnerable individuals, including those with prior ICH, cerebral amyloid angiopathy (CAA), or neuroimaging markers of cerebral small vessel disease (SVD). Left atrial appendage occlusion (LAAO) has emerged as an alternative stroke prevention strategy for patients with contraindications to anticoagulation; however, optimal patient selection and post-procedural antithrombotic management remain uncertain, largely because existing bleeding risk scores inadequately capture ICH risk. Most hemorrhagic risk scores were designed to estimate systemic bleeding and demonstrate limited ability to predict ICH, as they do not incorporate hemorrhage etiology or neuroimaging features. Importantly, ICH recurrence risk varies substantially by subtype, with the highest risk observed in CAA-related hemorrhage, the lowest in hypertensive SVD, and intermediate risk in mixed or secondary etiologies. These distinctions have direct implications for anticoagulation decisions and consideration of LAAO. Finally, we synthesize contemporary evidence on ICH risk stratification, neuroimaging biomarkers, and antithrombotic strategies following LAAO. We propose a multidisciplinary, evidence-based decision-making framework integrating clinical risk scores, neuroimaging findings, and hemorrhage phenotype to support individualized stroke prevention strategies in high-risk patients with AF.
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Daza-Ovalle et al. (2026) conducted a review in Atrial fibrillation. Left atrial appendage occlusion (LAAO) was evaluated. Left atrial appendage occlusion patient selection in high-risk atrial fibrillation can be optimized using a multidisciplinary framework integrating clinical risk scores and neuroimaging.
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