Has the CLOSURE-AF trial changed your threshold for referring a patient with atrial fibrillation for left atrial appendage closure?

The totality of data from recent clinical trials affirms that LAAO implantation should be viewed as a useful alternative strategy for patients at high risk of stroke and systemic embolism. Although closure can be used as a first-line treatment in select patients, I continue to recommend a trial of a DOAC in the majority. However, even in these patients, I do discuss the risks and benefits of both approaches so that informed individuals can participate in the decision-making process. One caveat is that we are soon to see the results of ongoing trials of Factor XIa inhibitors. If these drugs reduce the chance of bleeding even further than Xa inhibitors, the scale may tip further in the direction of medical treatment, even for patients who hav...