{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T01:01:08Z","timestamp":1780362068089,"version":"3.54.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008497","name":"Boston Scientific","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Concerns have been raised over the safety and necessity of continuing oral anticoagulation (OAC) in patients following catheter ablation for atrial fibrillation (AF). OPTION demonstrated the safety and efficacy of left atrial appendage closure (LAAC) in a post-ablation population. We sought to analyse the impact of baseline bleeding risk, per HAS-BLED scores, on the outcomes for patients in a pre-specified sub-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients with AF and high stroke risk undergoing catheter ablation were randomly assigned to LAAC vs. OAC in OPTION and were stratified by HAS-BLED score: 0, 1, 2, \u22653. OPTION enrolled 1600 patients (CHA2DS2-VASc score: 3.5 \u00b1 1.3; HAS-BLED score: 1.2 \u00b1 0.8); randomized 1:1 to ablation\/LAAC or ablation\/OAC. Primary effectiveness (all-cause death\/stroke\/systemic embolism) and safety (bleeding composite) endpoints were directionally similar in HAS-BLED subgroups; both thromboembolic and bleeding event rates were higher in patients with increasing HAS-BLED score. A significant reduction in primary safety bleeding events was noted in favour of LAAC across HAS-BLED subgroups, with more striking reductions noted for lower HAS-BLED scores of 0 (n = 265; hazard ratio: 0.25; 95% confidence interval: 0.20, 0.50) and 1 (n = 890; hazard ratio: 0.41, 95% confidence interval: 0.27\u20130.61).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Regardless of bleeding risk, LAAC is comparable to OAC in stroke protection while demonstrating greater freedom from bleeding in a post-ablation AF population, even in patients with low HAS-BLED scores. The OPTION study highlights an opportunity to mitigate future bleeding risk with a strategy of LAAC after ablation in patients deemed at high risk of stroke according to clinical guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>NCT03795298<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag093","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:26:36Z","timestamp":1776770796000},"source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous left atrial appendage closure following catheter ablation therapy of atrial fibrillation: outcomes stratified by bleeding risk \u2013 a sub-analysis of the OPTION study"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0031-5577","authenticated-orcid":false,"given":"Karen P","family":"Phillips","sequence":"first","affiliation":[{"name":"The Brisbane AF Clinic, Greenslopes Private Hospital , Suite 23, Greenslopes Specialist Centre, Newdegate Street, Greenslopes, Brisbane, Queensland 4120 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8253-947X","authenticated-orcid":false,"given":"Devi G","family":"Nair","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Division, St. Bernards Medical Center & Arrhythmia Research Group , Jonesboro, AR ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4591-4220","authenticated-orcid":false,"given":"Lucas V A","family":"Boersma","sequence":"additional","affiliation":[{"name":"Cardiology Department, St. Antonius Hospital, Nieuwegein and UMC , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5555-7672","authenticated-orcid":false,"given":"Rahul N","family":"Doshi","sequence":"additional","affiliation":[{"name":"Cardiac Electrophysiology Division, Arizona State University John Schufeldt School of Medicine and Advanced Medical Engineering , Scottsdale, AZ ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1216-7580","authenticated-orcid":false,"given":"Jeff S","family":"Healey","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, McMaster University , Hamilton, ON ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5642-2112","authenticated-orcid":false,"given":"Wael A","family":"Jaber","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3326-9973","authenticated-orcid":false,"given":"Moussa","family":"Mansour","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology, Massachusetts General Hospital , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5638-4993","authenticated-orcid":false,"given":"Vivek Y","family":"Reddy","sequence":"additional","affiliation":[{"name":"Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8500-8313","authenticated-orcid":false,"given":"Claudio","family":"Tondo","sequence":"additional","affiliation":[{"name":"Department of Clinical Electrophysiology & Cardiac Pacing Centro Cardiologico Monzino, IRCCS , Milan ,","place":["Italy"]},{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan , Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6601-944X","authenticated-orcid":false,"given":"Andrea","family":"Natale","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, St. David's Medical Center , Austin, TX ,","place":["USA"]},{"name":"Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4170-4309","authenticated-orcid":false,"given":"Aravin","family":"Sukumar","sequence":"additional","affiliation":[{"name":"Boston Scientific Corporation , Marlborough, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krystal","family":"Leger","sequence":"additional","affiliation":[{"name":"Boston Scientific Corporation , Marlborough, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Christen","sequence":"additional","affiliation":[{"name":"Boston Scientific Corporation , Marlborough, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad S","family":"Sutton","sequence":"additional","affiliation":[{"name":"Boston Scientific Corporation , Marlborough, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oussama M","family":"Wazni","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"2026060120021654700_euag093-B1","doi-asserted-by":"crossref","first-page":"e002597","DOI":"10.1161\/JAHA.115.002597","article-title":"Patterns of anticoagulation use and cardioembolic risk after catheter ablation for atrial fibrillation","volume":"4","author":"Noseworthy","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"2026060120021654700_euag093-B2","doi-asserted-by":"crossref","first-page":"2418","DOI":"10.1253\/circj.CJ-19-0602","article-title":"Current Status and clinical outcomes of oral anticoagulant discontinuation after ablation for atrial fibrillation in Japan\u2015 findings from the AF frontier ablation registry \u2015","volume":"83","author":"Okumura","year":"2019","journal-title":"Circ J"},{"key":"2026060120021654700_euag093-B3","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jacc.2023.08.017","article-title":"2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation","volume":"83","author":"Writing Committee Members","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"2026060120021654700_euag093-B4","doi-asserted-by":"crossref","first-page":"2478","DOI":"10.1093\/eurheartj\/ehw087","article-title":"Catheter ablation for atrial fibrillation is associated with lower incidence of stroke and death: data from Swedish health registries","volume":"37","author":"Friberg","year":"2016","journal-title":"Eur Heart J"},{"key":"2026060120021654700_euag093-B5","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1093\/eurheartj\/ehu421","article-title":"Oral anticoagulation therapy after radiofrequency ablation of atrial fibrillation and the risk of thromboembolism and serious bleeding: long-term follow-up in nationwide cohort of Denmark","volume":"36","author":"Karasoy","year":"2015","journal-title":"Eur Heart J"},{"key":"2026060120021654700_euag093-B6","doi-asserted-by":"crossref","first-page":"e251320","DOI":"10.1001\/jamanetworkopen.2025.1320","article-title":"Discontinuation of oral anticoagulation after successful atrial fibrillation ablation","volume":"8","author":"Iwawaki","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026060120021654700_euag093-B7","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1001\/jama.2025.14679","article-title":"Long-term anticoagulation discontinuation after catheter ablation for atrial fibrillation: the ALONE-AF randomized clinical trial","volume":"334","author":"Kim","year":"2025","journal-title":"JAMA"},{"key":"2026060120021654700_euag093-B8","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1056\/NEJMoa2408308","article-title":"Left atrial appendage closure after ablation for atrial fibrillation","volume":"392","author":"Wazni","year":"2025","journal-title":"N Engl J Med"},{"key":"2026060120021654700_euag093-B9","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ahj.2022.05.003","article-title":"Comparison of anticoagulation with left atrial appendage closure after AF ablation: rationale and design of the OPTION randomized trial","volume":"251","author":"Wazni","year":"2022","journal-title":"Am Heart J"},{"key":"2026060120021654700_euag093-B10","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1378\/chest.10-0134","article-title":"A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the euro heart survey","volume":"138","author":"Pisters","year":"2010","journal-title":"Chest"},{"key":"2026060120021654700_euag093-B11","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jacc.2010.09.024","article-title":"Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (hypertension, abnormal renal\/liver function, stroke, bleeding history or predisposition, labile INR, elderly, drugs\/alcohol concomitantly) score","volume":"57","author":"Lip","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2026060120021654700_euag093-B12","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual Life Res"},{"key":"2026060120021654700_euag093-B13","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-item short-form health survey: construction of scales and preliminary test of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med Care"},{"key":"2026060120021654700_euag093-B14","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1056\/NEJMoa1009638","article-title":"Rivaroxaban versus warfarin in nonvalvular atrial fibrillation","volume":"365","author":"Patel","year":"2011","journal-title":"N Engl J Med"},{"key":"2026060120021654700_euag093-B15","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1056\/NEJMoa1107039","article-title":"Apixaban versus warfarin in patients with atrial fibrillation","volume":"365","author":"Granger","year":"2011","journal-title":"N Engl J Med"},{"key":"2026060120021654700_euag093-B16","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1136\/heartjnl-2020-316781","article-title":"Community pharmacy-based study of adherence to non-vitamin K antagonist oral anticoagulants","volume":"106","author":"Capiau","year":"2020","journal-title":"Heart"},{"key":"2026060120021654700_euag093-B17","doi-asserted-by":"crossref","first-page":"euaf250","DOI":"10.1093\/europace\/euaf250","article-title":"Adherence to oral thromboprophylaxis in atrial fibrillation: an overview for clinicians","volume":"27","author":"Potpara","year":"2025","journal-title":"Europace"},{"key":"2026060120021654700_euag093-B18","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS) developed by the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC), with the special contribution of the European heart rhythm association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"2026060120021654700_euag093-B19","doi-asserted-by":"crossref","first-page":"euae298","DOI":"10.1093\/europace\/euae298","article-title":"Spotlight on the 2024 ESC\/EACTS management of atrial fibrillation guidelines: 10 novel key aspects","volume":"26","author":"Rienstra","year":"2024","journal-title":"Europace"},{"key":"2026060120021654700_euag093-B20","doi-asserted-by":"crossref","first-page":"euae035","DOI":"10.1093\/europace\/euae035","article-title":"Practical guide on left atrial appendage closure for the non-implanting physician: an international consensus paper","volume":"26","author":"Potpara","year":"2024","journal-title":"Europace"},{"key":"2026060120021654700_euag093-B21","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1056\/NEJMoa2509688","article-title":"Antithrombotic therapy after successful catheter ablation for atrial fibrillation","volume":"394","author":"Verma","year":"2026","journal-title":"N Engl J Med"},{"key":"2026060120021654700_euag093-B22","author":"Landmesser"},{"key":"2026060120021654700_euag093-B23","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ejim.2024.06.022","article-title":"Performance of HAS-BLED and DOAC scores to predict major bleeding events in atrial fibrillation patients treated with direct oral anticoagulants: a report from a prospective European observational registry","volume":"128","author":"Mei","year":"2024","journal-title":"Eur J Intern Med"},{"key":"2026060120021654700_euag093-B24","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1161\/CIRCULATIONAHA.121.057063","article-title":"AmplatzerTM amuletTM left atrial appendage occluder versus watchmanTM device for stroke prophylaxis (amulet ide): a randomized controlled trial","volume":"144","author":"Lakkireddy","year":"2021","journal-title":"Circulation"},{"key":"2026060120021654700_euag093-B25","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1161\/CIRCEP.113.000869","article-title":"Renal dysfunction, stroke risk scores (CHADS2, CHA2DS2-VASc, and R2CHADS2), and the risk of thromboembolic events after catheter ablation of atrial fibrillation","volume":"6","author":"Kornej","year":"2013","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2026060120021654700_euag093-B26","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1016\/j.jacc.2013.01.061","article-title":"Quality of life assessment in the randomized PROTECT AF (percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation) trial of patients at risk for stroke with nonvalvular atrial fibrillation","volume":"61","author":"Alli","year":"2013","journal-title":"J Am Coll Cardiol"}],"container-title":["Europace"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/28\/6\/euag093\/68443038\/euag093.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/28\/6\/euag093\/68443038\/euag093.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:02:26Z","timestamp":1780358546000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/doi\/10.1093\/europace\/euag093\/8699394"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,2]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euag093","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"value":"1099-5129","type":"print"},{"value":"1532-2092","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,6]]},"article-number":"euag093"}}