54
Management
Table 14. Situations in Which Long-Term Anticoagulation Is
Contraindicated and Situations When It Remains
Reasonable
Long-Term Anticoagulation
Contraindicated
Long-Term Anticoagulation is Still
Reasonable
• Severe bleeding due to a nonreversible
cause involving the gastrointestinal,
pulmonary, or genitourinary systems
• Spontaneous intracranial/intraspinal
bleeding due to a nonreversible cause
• Serious bleeding related to recurrent
falls when cause of falls is not felt to be
treatable
• Bleeding involving the gastrointestinal,
pulmonary, or genitourinary systems
that is treatable
• Bleeding related to isolated trauma
• Bleeding related to procedural
complications
6.5.1. Percutaneous Approaches to Occlude the Left Atrial
Appendage (LAA)
COR LOE
Recommendations
2a B-NR 1. In patients with AF, a moderate to high risk of stroke
(CHAD
2
DS
2
-VASc score ≥2), and a contraindication (Table
14) to long-term oral anticoagulation due to a nonreversible
cause, percutaneous LAAO (pLAAO) is reasonable.
2b B-R 2. In patients with AF and a moderate to high risk of stroke and
a high risk of major bleeding on oral anticoagulation, pLAAO
may be a reasonable alternative to oral anticoagulation
based on patient preference, with careful consideration of
procedural risk and with the understanding that the evidence
for oral anticoagulation is more extensive.
