Ocular Outcomes Comparing the Left Atrial Appendage Occlusion Device to Systemic Anticoagulation Therapy

Authors

Tristan Yeung
Amer Alsoudi, Corewell Health East
Euno Koo
Karen Wai
Prithvi Mruthyunjaya
Ehsan Rahimy

Document Type

Conference Proceeding

Publication Date

6-2025

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : Left atrial appendage closure (LAAO) devices reduce the risk of thromboembolism in high-risk patients with atrial fibrillation (AFib) without the need for systemic anticoagulation, but their ocular safety is unclear. This study assessed the incidence rate of neovascular age-related macular degeneration (AMD), intraocular bleeding, and procedural intervention in patients with the LAAO device versus those on warfarin or direct oral anticoagulants (DOACs).

Methods : TriNetX U.S. Network was queried from 2015 to 2024 for AFib patients managed with either the LAAO device, warfarin, or DOACs using ICD-10, CPT, and RxNorm codes. Incidence and incidence rate ratios (IRR) were calculated for outcomes including neovascular AMD, macular hemorrhage (MH), vitreous hemorrhage (VH), and anti-VEGF intravitreal injection therapy. Index date was set three months post-implantation for the LAAO device cohort and at the first anticoagulant prescription for the warfarin or DOAC cohorts. Any patient with a history of the outcomes was excluded, as were LAAO device patients with anticoagulation use after three months post-implantation.

Results : LAAO device had a lower rate of neovascular AMD than warfarin (IRR: 0.70, 95% CI: 0.51-0.97) but a higher rate than DOACs (IRR: 1.45, 95% CI: 1.06-1.98). Compared to warfarin, LAAO device showed a significantly lower rate of MH (IRR: 0.31, 95% CI: 0.17-0.55), VH (IRR: 0.26, 95% CI: 0.14-0.49), and anti-VEGF injections (IRR: 0.28, 95% CI: 0.16-0.48). No significant rate differences were observed between LAAO device and DOACs for MH (IRR: 0.89, 95% CI: 0.50-1.57), VH (IRR: 0.77, 95% CI: 0.41-1.44), or anti-VEGF injections (IRR: 0.85, 95% CI: 0.50-1.44). A subgroup analysis of non-neovascular AMD patients revealed a lower rate of neovascular conversion (IRR: 0.48, 95% CI: 0.30-0.76) and anti-VEGF injections (IRR: 0.44, 95% CI: 0.24-0.84) when comparing LAAO device to warfarin. No significant rate differences were seen for neovascular conversion (IRR: 0.72, 95% CI: 0.46-1.13) and anti-VEGF injections (IRR: 0.83, 95% CI: 0.44-1.54) when comparing LAAO device to DOACs.

Conclusions : LAAO device patients were less likely to have neovascular AMD conversion, intraocular bleeding, or anti-VEGF injections compared to warfarin patients, with outcomes similar to DOAC patients. LAAO device may be helpful in managing patients at high risk for neovascular AMD or intraocular bleeding.

Volume

66

Issue

8

First Page

4109

Comments

Association for Research in Vision and Ophthalmology ARVO Annual Meeting, May 4-8, 2025, Salt Lake City, UT

Last Page

4109

Recommended Citation

Yeung T, Alsoudi A, Koo E, Wai K, Mruthyunjaya P, Rahimy E. Ocular outcomes comparing the left atrial appendage occlusion device to systemic anticoagulation therapy. Invest Ophthal Vis Sci. 2025 Jun;66(8):4109.