{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:33:44Z","timestamp":1780403624144,"version":"3.54.1"},"reference-count":42,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T00:00:00Z","timestamp":1712016000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Among patients with atrial fibrillation (AF), a nonpharmacologic option (e.g., percutaneous left atrial appendage occlusion [LAAO]) is needed for patients with oral anticoagulant (OAC) contraindications. Among beneficiaries in the Medicare fee\u2010for\u2010service coverage 20% sample databases (2015\u201318) who had AF and an elevated CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc score, we assessed the association between percutaneous LAAO versus OAC use and risk of stroke, hospitalized bleeding, and death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients undergoing percutaneous LAAO were matched to up to five OAC users by sex, age, date of enrollment, index date, CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc score, and HAS\u2010BLED score. Overall, 17\u2009156 patients with AF (2905 with percutaneous LAAO) were matched (average\u2009\u00b1\u2009SD 78\u2009\u00b1\u20096\u2009years, 44% female). Cox proportional hazards model were used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median follow\u2010up was 10.3\u2009months. After multivariable adjustments, no significant difference for risk of stroke or death was noted when patients with percutaneous LAAO were compared with OAC users (HRs [95% CIs]: 1.14 [0.86\u20131.52], 0.98 [0.86\u20131.10]). There was a 2.94\u2010fold (95% CI: 2.50\u20133.45) increased risk for hospitalized bleeding for percutaneous LAAO compared with OAC use. Among patients 65 to &lt;78\u2009years old, those undergoing percutaneous LAAO had higher risk of stroke compared with OAC users. No association was present in those \u226578\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this analysis of real\u2010world AF patients, percutaneous LAAO versus OAC use was associated with similar risk of death, nonsignificantly elevated risk of stroke, and an elevated risk of bleeding in the post\u2010procedural period. Overall, these results support results of randomized trials that percutaneous LAAO may be an alternative to OAC use for patients with contraindications.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5786","type":"journal-article","created":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T02:48:34Z","timestamp":1712112514000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Percutaneous left atrial appendage occlusion and risk of stroke, hospitalized bleeding and death in Medicare beneficiaries"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6025-0173","authenticated-orcid":false,"given":"Wendy","family":"Wang","sequence":"first","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin Yee","family":"Chen","sequence":"additional","affiliation":[{"name":"Lillehei Heart Institute and Department of Medicine (Cardiovascular Division) University of Minnesota Medical School  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob F.","family":"Walker","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Alonso","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faye L.","family":"Norby","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamakshi","family":"Lakshminarayan","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health University of Minnesota  Minneapolis Minnesota USA"},{"name":"Department of Neurology University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela L.","family":"Lutsey","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000950"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1987.00370090041008"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000665"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw330"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0003\u20104975(95)00887\u2010X"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2014.08.009"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2225\u2010319X.2013.12.06"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2018.09.025"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.021"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.04.067"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.10.023"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(09)61343\u2010X"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.029"},{"key":"e_1_2_9_15_1","unstructured":"U.S.Centers for Medicare and Medicaid Services Parts of Medicare.https:\/\/www.medicare.gov\/basics\/get-started-with-medicare\/medicare-basics\/parts-of-medicare"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.2317"},{"key":"e_1_2_9_17_1","unstructured":"Division of Biomedical Statistics and Informatics MCR.Biomedical Statistics and Informatics.https:\/\/bioinformaticstools.mayo.edu\/research\/gmatch\/files\/4287\/gmatch.html"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.2312"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.2109"},{"key":"e_1_2_9_20_1","unstructured":"ResDAC.Death information in the research identifiable medicare data. 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