Abstract Body (Do not enter title and authors here): Background: Patients with nonvalvular atrial fibrillation (AF) and a history of intracranial bleeding while on anticoagulant therapy commonly undergo left atrial appendage occlusion (LAAO) to prevent thromboembolic events. Despite being suitable candidates for LAAO, treatment for this patient population is underrepresented in clinical trials.
Methods: PubMed, Cochrane, and Embase databases were systematically searched for studies reporting clinical outcomes after LAAO in patients with prior intracranial bleeding. Pooled incidence data were presented as mean percentages with 95% confidence intervals (CI) using a random-effects model.
Results: A total of 20 observational studies were included comprising 1,945 patients with nonvalvular AF and prior intracranial bleeding receiving LAAO. The mean age was 73.2 years, 35.2% were women, 49.8% received Watchman device. The mean CHA₂DS₂-VASc was 4.48 and the mean HAS-BLED was 3.74. In patients with prior intracranial bleeding, the LAAO procedure was associated with an all-cause mortality pooled incidence rate of 4.42% (95% CI 2.40-8.02; I²=81%, Figure 1A), major bleeding rate of 3.93% (95% CI 2.43-6.30; I²=54%, Figure 1B), device-related thrombosis rate of 1.46% (95% CI 0.83-2.66; I²=0%), peri device leak rate of 4.70% (95% CI 1.61-12.97; I²=86%), and stroke rate of 3.48% (95% CI 2.14-5.63; I²=47%).
Conclusion: This meta-analysis of 20 studies found that, in patients with history of intracranial bleeding receiving LAAO, the incidence of clinical outcomes is comparable to the overall population undergoing LAAO.