Regardless of bleeding risk, LAAC is comparable to OAC in stroke protection while demonstrating greater freedom from bleeding in a post-ablation AF population, even in patients with low HAS-BLED scores.
LAAC demonstrated a significant reduction in primary safety bleeding events compared to OAC across all HAS-BLED subgroups in post-ablation AF patients.
Primary effectiveness outcomes (all-cause death, stroke, systemic embolism) were directionally similar between LAAC and OAC across all HAS-BLED subgroups.
The OPTION trial enrolled 1600 patients with AF and high stroke risk undergoing catheter ablation, randomized 1:1 to ablation/LAAC or ablation/OAC.
Both thromboembolic and bleeding event rates increased with higher HAS-BLED scores in the study population.
LAAC after catheter ablation presents an opportunity to mitigate future bleeding risk even in patients with low baseline bleeding risk scores.
This research examined whether a small device implanted in the heart (left atrial appendage closure, or LAAC) might be better than blood thinners (oral anticoagulation, OAC) for preventing strokes after a heart rhythm procedure called catheter ablation in patients with atrial fibrillation (AF). The study analyzed data from 1,600 patients in the OPTION trial, grouping them by their bleeding risk level using a standard scoring tool called HAS-BLED. Patients were randomly assigned to receive either LAAC or continue on blood thinners after their ablation procedure. The study found that LAAC was just as effective as blood thinners at preventing strokes and other clot-related events, regardless of patients' baseline bleeding risk. More notably, LAAC led to significantly fewer bleeding events across all risk groups, including patients who were considered low bleeding risk (HAS-BLED scores of 0 and 1). The reduction in bleeding was particularly pronounced in these lower-risk groups, with patients at the lowest risk (score of 0) showing a 75% lower hazard of bleeding with LAAC compared to blood thinners. This research suggests that LAAC after catheter ablation may offer a meaningful way to reduce the long-term burden of bleeding associated with blood thinners, even in patients who are not typically considered high bleeding risk. These findings may be relevant for clinicians and patients considering how to manage stroke prevention after AF ablation, particularly since the bleeding benefit appeared across the full spectrum of bleeding risk profiles studied.
Phillips K, Nair D, Boersma L, Doshi R, Healey J, Jaber W, et al.. (2026). Percutaneous left atrial appendage closure following catheter ablation therapy of atrial fibrillation: outcomes stratified by bleeding risk - a sub-analysis of the OPTION study.. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. https://doi.org/10.1093/europace/euag093