The safety and efficacy of left atrial appendage closure devices in patients with non-traumatic intracranial hemorrhage.

Background: Anticoagulation in patients with atrial fibrillation and a history of intracranial hemorrhage (ICH) presents with challenges when balancing the risk of recurrent bleeding vs ischemic stroke. Left atrial appendage closure (LAAC) devices have shown promise as a minimally invasive method to prevent stroke without long-term anticoagulation. The goal of our study is to evaluate the efficacy of LAAC devices in patients with non-traumatic ICH and intraspinal hemorrhage which has not been well studied.

Methods: A retrospective analysis on patients who had a history of atrial fibrillation and ICH/intraspinal hemorrhage was performed. The primary outcome was the development of new hemorrhage or ischemic stroke. Secondary outcomes included procedural complications and mortality.

Results: 103 patients were included with a mean follow-up time of 1341 ± 764 days. All patients had successful LAAC placement. 7 patients developed periprocedural complications including groin hematoma, stroke, and pericarditis. 43 had a peri-device leak of any size including 3 device related thrombus. 11 patients suffered a new ischemic stroke with an annualized incidence rate of 2.9 % and 6 suffered a recurrent hemorrhage with an annualized incidence rate of 1.6 %. Those who suffered a new stroke were more likely to have a history of prior stroke (p = 0.04) and had a larger peri-device leak (4.3 vs 2.7 mm, p = 0.04). There was no difference in patient characteristics in those who suffered an ICH.

Conclusions: LAAC devices appear to be a safe and effective alternative to anticoagulation in patients with a history of nontraumatic ICH or intraspinal hemorrhage.