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A sex-specific analysis of the CLOSURE-AF trial found that older women with atrial fibrillation fared significantly worse with left atrial appendage occlusion (LAAO) compared to medical therapy — primarily due to higher cardiovascular death rates — while men saw no such difference. The findings, presented at ESC Congress 2026, are prompting cardiologists to think twice before choosing LAAO over DOACs in elderly women who can tolerate anticoagulation.
A new sex-specific analysis of the CLOSURE-AF trial is raising important questions about who should — and shouldn't — receive left atrial appendage occlusion (LAAO) for atrial fibrillation (AFib). Presented at the European Society of Cardiology Congress 2026 in Munich, the data show that older women with AFib had significantly worse outcomes with LAAO compared to best medical care (mostly DOACs), while men showed no meaningful difference between the two approaches.
The key driver of the disparity was cardiovascular and unexplained death. Among women, LAAO was associated with a 66% higher risk of the primary composite endpoint (stroke, systemic embolism, major bleeding, or CV/unexplained death) compared to medical therapy — a stark contrast to the near-neutral effect seen in men. The cause remains unclear, with researchers ruling out procedural complications and device sizing as explanations.
By the Numbers:
Why it matters: These findings suggest sex may be a critical factor when selecting patients for LAAO. Clinicians are being urged to reconsider LAAO — especially in frail, elderly women who can tolerate DOAC therapy — until more data clarify the underlying mechanism.
