Left atrial appendage occlusion for intracerebral haemorrhage patients with atrial fibrillation

The best way to prevent further stroke in intracerebral haemorrhage (ICH) survivors with atrial fibrillation (AF) continues to be an area of uncertainty for clinicians.

Left atrial appendage occlusion (LAAO) is considered an alternative treatment option to anticoagulants for these patients.

However, ICH survivors with AF have historically been excluded from randomised controlled trials about LAAO, meaning there is only limited evidence from observational studies regarding its role in treating this high-risk patient population.

In conversation with Professor Gregory Lip

In this interview, Dr Eleni Korompoki and Professor Gregory Lip discuss the evidence behind LAAO for ICH survivors with AF, and what the right course of action might be for these patients.

Watch their conversation on YouTube:

Or listen on SoundCloud:

Take home messages

After discussing with Professor Lip, Dr Korompoki summarises the take home messages as the following:

1. Compared to trials studying oral anticoagulants for stroke prevention in cases of atrial fibrillation, randomised controlled trials comparing LAAO and anticoagulation were very small;
2. Available data for LAAO in ICH patients with AF is only based on observational studies with substantial risk of bias;
3. Enrolling ICH patients with AF into randomised controlled trials comparing LAAO and anticoagulants is currently the best option for these patients.

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Use the following guide to direct yourself to different sections of the conversation:

00:00 – introduction

01:55 – could you please give us an overview of data supporting stroke prevention in patients with AF by LAAO?

04:27 – what are the strengths and limitations of available trials on LAAO?

07:29 – what about PRAGUE-17 that compares LAAO with direct oral anticoagulants?

09:20 – looking specifically at ICH patients with AF, what is the current evidence for stroke prevention using LAAO?

11:10 – what are the limitations of LAAO for these patients?

12:59 – what about anti-thrombotics post-LAAO?

13:55 – in your opinion, should stroke centres recommend participation in randomised controlled trials of anticoagulation vs no anticoagulation, or refer patients for LAAO?

15:39 – how many ICH patients with AF do you usually refer to LAAO? The majority or just a few?

16:58 – in conclusion, what is your current recommendation for stroke prevention for ICH patients with AF?

20:00 – take home messages