Work

Beyond anticoagulation: defining the role of left atrial appendage closure in stroke prevention for atrial fibrillation

Year: 2026

Type: article

Abstract: Oral anticoagulation has a very strong evidence base for stroke prevention in patients with atrial fibrillation (AF) at elevated thromboembolic risk. Direct oral anticoagulants have improved the safety and convenience of treatment, yet important limitations remain, including residual ischaemic stroke, major bleeding, treatment discontinuation, and patient refusal. Left atrial appendage closure (LAAC) offers an alternative strategy for selected patients by excluding the principal anatomical source of AF-related cardiac thrombi. However, the appropriate role of LAAC remains controversial, particularly in patients who can and do tolerate anticoagulation. This viewpoint argues for a more individualized approach that distinguishes absolute contraindications from modifiable bleeding risks, treatment refusal or non-persistence, and stroke occurring despite adequate anticoagulation.

Source: EP Europace

DOI: 10.1093/europace/euag296

Author: A John Camm

Institution: City St George's, University of London

Language: English

Topic: Atrial Fibrillation Management and Outcomes

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,909