Introduction: The hybrid strategy, defined as left atrial appendage closure (LAAC) followed by long‑term anticoagulation, may be considered in patients with thromboembolic events or left atrial appendage thrombus despite anticoagulation (anticoagulation failure).

Objectives: To report the adoption and outcomes of the hybrid strategy.

Patients and methods: High‑volume Polish centers reported outcomes of LAAC after anticoagulation failure between 2014 and 2024. The hybrid strategy was compared with other pharmacotherapy regimens (non‑hybrid) with respect to thromboembolic events, device‑related thrombus (DRT), and major bleeding.

Results: Out of 1,625 LAAC procedures across 5 centers, 141 patients (8.7%) had a history of anticoagulation failure. The hybrid strategy was applied in n=64 (45%) and increased from none in 2014 to 80% of patients in 2024. Compared with the non‑hybrid group, hybrid strategy patients received newer‑generation occluders (98.4% vs 68.8%, P<0.001), had less prior bleeding (12.5% vs 35.1%, P=0.003), lower HAS‑BLED scores [3 (2‑3) vs 3 (2‑4), P=0.008], more often had prior appendage thrombus (23.4% vs 10.4%, P=0.042) and LVEF<40% (18.8% vs 6.5%, P=0.037). During a median 1.3‑year follow‑up, the hybrid strategy showed greater thromboembolic risk reduction relative to CHA₂DS₂-VASc‑predicted (91% vs 60%; annualized event rates of 1.1% vs 5.5%), and greater major bleeding risk reduction relative to HAS‑BLED‑predicted (100% vs 73%; annualized rates of 0.0% vs 1.7%), with similar DRT rates (6.9% vs 6.8%, P=1.000).

Conclusions: The hybrid strategy after LAAC for anticoagulation failure is increasingly adopted and was associated with greater thromboembolic risk reduction compared with the standard non‑hybrid strategy, without compromising the bleeding profile.