Abstract Number: Esoc2026ot4 Percutaneous Left Atrial Appendage Closure for Patients With Atrial Fibrillation-Related Ischemic Stroke Despite Anticoagulation: Afida 1 & 2 Studies

Background and aims Anticoagulation effectively prevents recurrent ischemic events. However, AF-related ischemic stroke despite anticoagulation (AFIDA) carries an approximately 1.5-fold higher risk of recurrent ischemic stroke than strokes occurring without oral anticoagulants, highlighting the urgent need for novel preventive strategies. Percutaneous left atrial appendage closure (LAAC) is reimbursed in Japan for patients at high bleeding risk (e.g., HAS-BLED ≥3) with planned discontinuation of antithrombotic therapy, and meta-analyses of the PROTECT AF and PREVAIL trials demonstrated that LAAC significantly reduces disabling or fatal stroke (mRS ≥2) compared with warfarin with non-significant increase of ischemic stroke or systemic embolism. Methods To evaluate the efficacy and safety of LAAC in AFIDA. Results A multicenter, prospective, single-arm interventional trial in which cardiologists and stroke specialists collaboratively perform LAAC in 180 AFIDA patients (AFIDA2) is ongoing. Continuation of oral anticoagulation during follow-up will be individualized according to ischemic and bleeding risk profiles. In parallel, we will establish a multicenter prospective cohort of 520 AFIDA patients (AFIDA1), enabling integrated analysis of the interventional and observational arms. Conclusions The primary composite endpoint is 1-year incidence of ischemic stroke or systemic embolism. Conflict of interest