Why the study?
Does adding percutaneous left atrial appendage occlusion to ongoing anticoagulation prevent recurrent ischemic stroke in patients with atrial fibrillation who experience a stroke despite anticoagulation?
Does adding percutaneous left atrial appendage occlusion to ongoing anticoagulation prevent recurrent ischemic stroke in patients with atrial fibrillation who experience a stroke despite anticoagulation?
Adding LAAO to ongoing anticoagulation may be an effective secondary prevention strategy for patients with atrial fibrillation who experience an ischemic stroke despite appropriate DOAC therapy.
Hypothesis-generating for LAAO plus continued DOAC in AF with breakthrough stroke; should not yet change practice.
A 79-year-old woman developed weakness in her right upper and lower limbs despite appropriate therapy with edoxaban 30 mg once daily for non-valvular atrial fibrillation (CHA2DS2-VASc score of 7, HAS-BLED score of 3). Brain MRI revealed an acute infarct in the territory of the left long insular artery or white-matter medullary artery. Transesophageal echocardiogram showed spontaneous echo contrast and reduced flow velocities in the left atrial appendage (LAA), leading to a diagnosis of cardioembolic stroke. Edoxaban was continued, and the patient underwent percutaneous left atrial appendage occlusion (LAAO). Her clinical course was uncomplicated by recurrent ischemic stroke or device-related thrombosis. For patients with atrial fibrillation-related ischemic stroke despite anticoagulation, adding LAAO to ongoing anticoagulation may be an effective option for secondary prevention.
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Kawabata et al. (2026) studied this question.
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