PERCUTANEOUS left atrial appendage occlusion has been associated with a lower risk of bleeding and death compared to oral anticoagulant therapy among dialysis patients with kidney failure and nonvalvular atrial fibrillation, a new cohort study finds. These results highlight the potential of occlusion procedures to enhance safety in a group where stroke prevention is often complicated by haemorrhage risk.
Atrial fibrillation is common among individuals undergoing long-term dialysis for kidney failure and substantially increases their risk of stroke and death. Traditionally, oral anticoagulants are prescribed to mitigate this risk but often predispose patients to serious bleeding events. The need for safer, more effective alternatives has driven recent interest in left atrial appendage occlusion, a minimally invasive procedure that reduces cardiac thromboembolic risk by sealing off the appendage where clots commonly form.
In this US multi-centre study, 2344 patients with kidney failure and atrial fibrillation were retrospectively assessed after the start of long-term dialysis. Of these, 293 received left atrial appendage occlusion and 2051 received oral anticoagulants. Patients were followed for a median of 22 months. Those undergoing occlusion experienced 27 per cent mortality, 7.2 per cent nonfatal strokes and 39.9 per cent recurrent bleeding. By comparison, oral anticoagulant therapy led to higher rates: 35.5 per cent mortality, 8 per cent strokes and 33.5 per cent bleeding events, with more than 1100 bleeds across the group. Statistical modelling confirmed a significant association between occlusion and reduced risk of bleeding (hazard ratio 0.74), and improved survival (hazard ratio 0.47), with adjusted analysis showing comparable stroke protection between therapies.
For clinicians, these findings suggest that left atrial appendage occlusion may offer a safer option for stroke risk reduction in dialysis patients with kidney failure and atrial fibrillation, facilitating shared decision-making where bleeding risk is a major concern. Further prospective studies are needed to clarify long-term outcomes and help guide clinical recommendations.
Reference
Dhar G et al. Left Atrial appendage occlusion vs anticoagulants in dialysis with atrial fibrillation. JAMA Netw Open. 2025;8(9):e2530990.
