Gender differences on outcomes in left atrial appendage closure: An update

Caroline Kleinecke, Bernhard Meier, Steffen Gloekler

Left Atrial Appendage Closure (LAAC) is an alternative to Oral Anticoagulation (OAC) for stroke prevention in selected patients with Atrial Fibrillation (AF). According to current guidelines, this procedure is recommended for patients with contraindications to OAC, prior bleeds, or an elevated bleeding risk. Growing evidence shows that LAAC provides stroke prevention comparable to OAC. Additionally, a notable reduction of bleeding events and its associated mortality is achieved by LAAC. Women with AF have an increased risk for ischemic strokes and compared to male patients strokes tend to be more severe. However, due to concerns of bleeding in elderly women, underuse or underdosing of OAC is often observed in females. Therefore, women may have an increased benefit from LAAC. Gender differences have been described in other cardiac interventions and especially periprocedural complications occur more often in women. Recent studies have analyzed gender disparities of large, multicenter and realword registries in patients undergoing LAAC with respect to patient selection, device utilization, as well as periprocedural and clinical outcomes. In this mini-review, we summarize the results of those studies.