Left Atrial Appendage Occlusion (LAAO)
Left Atrial Appendage Closure (LAAC)
Who is it for?
People with AFib who have a reason not to take blood thinners may be candidates for LAAO procedures. Such people may have:
- A history of bleeding
- Risk factors for bleeding, such as
- Frequent falls or balance problems
- Kidney failure
- Liver failure
- Low platelet counts
- Previous stroke
LAAO presents a safe alternative to blood thinners for these people. Below is a comparison of LAAO and OAC:
Comparison of LAAO vs. Oral Anticoagulation OAC
| LAAO | OAC | |
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Purpose
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A procedure that physically blocks the left atrial appendage (a small pouch in the heart) to prevent blood clots from forming there and causing a stroke. The left atrial appendage is where most stroke-causing clots form in people with AFib.
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Medications (e.g., warfarin, apixaban, rivaroxaban) that thin the blood to reduce the risk of clots forming anywhere in the bloodstream.
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How It Works
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Involves a one-time, minimally invasive procedure in which a device is implanted into the heart through a small catheter inserted from a vein in the upper leg. The device closes left atrial appendage, and tissue grows over the device in approximately 6 weeks, permanently excluding the left atrial appendage from the heart. Without an open left atrial appendage, no stroke-causing blood clot can form there. |
Requires taking daily or twice daily pills indefinitely to maintain consistent blood thinning, which prevents blood from clotting in the left atrial appendage.
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Effectiveness
Both options significantly reduce the risk of stroke in people with AFib with comparable success. |
Works by closing the left atrial appendage, where most AFib-related clots form.
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Protects against clots forming in the left atrial appendage. Also prevents blood clots from forming elsewhere in the bloodstream, so OAC may be recommended for people with other clotting problems in addition to AFib. |
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Risks and Side Effects
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Risk of complications during the procedure include:
For most people, short-term medication is needed after implantation to prevent blood from clotting on the device. A small number of people may need longer-term blood thinners due to incomplete left atrial appendage closure or incomplete tissue growth over the device.
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Increased risk of bleeding (including major bleeding, such as gastrointestinal or brain bleeding). Other side effects may include:
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Maintenance
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After the procedure and initial healing, no ongoing maintenance. Long-term aspirin use is common if tolerated. Requires short-term follow-up to image the device.
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Requires consistent daily or twice daily medication use, and some types (e.g., warfarin) may require frequent blood tests to monitor clotting levels. |