What question did this study set out to answer?

To investigate whether left atrial appendage closure (LAAC) improves stroke prevention and bleeding outcomes in patients with atrial fibrillation who experience an ischemic stroke despite oral anticoagulation.

November 21, 2025Circulation JournalOpen Access

Management Strategies for Patients With Atrial Fibrillation-Related Ischemic Stroke Despite Oral Anticoagulation

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Why the study?

In patients with atrial fibrillation-related ischemic stroke despite oral anticoagulation, left atrial appendage closure may be an additional strategy to prevent further stroke events.

Does left atrial appendage closure added to oral anticoagulation reduce stroke and bleeding events in patients with atrial fibrillation-related ischemic stroke despite oral anticoagulation?

Population

Patients with atrial fibrillation-related ischemic stroke despite oral anticoagulation (AFIDA)

Comparison

+LAAC vs OAC alone

Follow-up

3 years

Authors

RCRyuki ChataniKurashiki Central Hospital MKMasanori KinosadaKurashiki Central Hospital KKKazuhisa KanedaKyoto University

Discussion

Member takes

Implication

LAAC addition should not yet change practice after OAC-failure stroke; leaves open possible reductions in fatal events.

Key Points

To investigate whether left atrial appendage closure (LAAC) improves stroke prevention and bleeding outcomes in patients with atrial fibrillation who experience an ischemic stroke despite oral anticoagulation.
Compared outcomes between patients treated with oral anticoagulation alone (OAC alone) and those receiving left atrial appendage closure (+LAAC).
Assessed 3-year cumulative incidence rates for ischemic stroke, major bleeding, fatal or disabling stroke, and fatal bleeding.
Performed propensity score-matched and subgroup analyses to adjust for baseline confounding.
Three-year cumulative incidence of ischemic stroke (15.2% vs. 14.5%, log-rank P=0.75) and major bleeding (23.4% vs. 5.3%, log-rank P=0.38) did not differ significantly between OAC alone and +LAAC groups.
Rates of fatal or disabling stroke (14.7% vs. 3.4%, log-rank P=0.06) and fatal bleeding (6.0% vs. 0%, log-rank P=0.03) were lower in the +LAAC group compared with OAC alone.
Fatal bleeding occurred exclusively among patients who were switched to aggressive oral anticoagulation regimens.

Structured PICO

Does left atrial appendage closure added to oral anticoagulation reduce stroke and bleeding events in patients with atrial fibrillation-related ischemic stroke despite oral anticoagulation?

Population

Patients with atrial fibrillation-related ischemic stroke despite oral anticoagulation (AFIDA)

Intervention

Left atrial appendage closure (LAAC) added to oral anticoagulation (+LAAC)

Comparator

Oral anticoagulation (OAC) alone

Outcome

3-year cumulative incidence of ischemic stroke and major bleedinghard clinical

In patients with ischemic stroke despite oral anticoagulation, adding left atrial appendage closure may reduce fatal bleeding and fatal or disabling stroke compared to oral anticoagulation alone.

Limitations

Observational design (hypothesis-generating findings requiring RCTs)

Cite This Study

Chatani et al. (2025) studied this question.

synapsesocial.com/papers/69f41cc8f3e494ed2b7d0299 https://doi.org/10.1253/circj.cj-25-0678

Topics

Left atrial appendage closure Atrial fibrillation Persistent AF management Anticoagulation in AF

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Management Strategies for Patients With Atrial Fibrillation-Related Ischemic Stroke Despite Oral Anticoagulation

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Management Strategies for Patients With Atrial Fibrillation-Related Ischemic Stroke Despite Oral Anticoagulation

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider