Left atrial appendage occlusion for stroke despite oral anticoagulation (resistant stroke). Results from the Amplatzer Cardiac Plug registry.

Cruz-González, Ignacio; González-Ferreiro, Rocío; Freixa, Xavier; Gafoor, Sameer; Shakir, Samera; Omran, Heyder; Berti, Sergio; Santoro, Gennaro; Kefer, Joelle; Landmesser, Ulf; Nielsen-Kudsk, Jens Erik; Kanagaratnam, Prapa; Nietlispach, Fabian; Gloekler, Steffen; Aminian, Adel; Danna, Paolo; Rezzaghi, Marco; Stock, Friederike; Stolcova, Miroslava; Paiva, Luis; ... (2020). Left atrial appendage occlusion for stroke despite oral anticoagulation (resistant stroke). Results from the Amplatzer Cardiac Plug registry. Revista española de cardiología (English ed.), 73(1), pp. 28-34. Elsevier 10.1016/j.rec.2019.02.013

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INTRODUCTION AND OBJECTIVES Despite the efficacy of oral anticoagulant (OAC) therapy, some patients continue to have a high residual risk and develop a stroke on OAC therapy (resistant stroke [RS]), and there is a lack of evidence on the management of these patients. The aim of this study was to analyze the safety and efficacy of left atrial appendage occlusion (LAAO) as secondary prevention in patients with nonvalvular atrial fibrillation who have experienced a stroke/transient ischemic attack despite OAC treatment. METHODS We analyzed data from the Amplatzer Cardiac Plug multicenter registry on 1047 consecutive patients with nonvalvular atrial fibrillation undergoing LAAO. Patientes with previous stroke on OAC therapy as indication for LAAO were identified and compared with patients with other indications. RESULTS A total of 115 patients (11%) with RS were identified. The CHA2DS2-VASc and the HAS-BLED score were significantly higher in the RS group (respectively 5.5±1.5 vs 4.3±1.6; P <.001; 3.9±1.3 vs 3.1±1.2; P <.001). No significant differences were observed in periprocedural major safety events (7.8 vs 4.5%; P=.1). With a mean clinical follow-up of 16.2±12.2 months, the observed annual stroke/transient ischemic attack rate for the RS group was 2.6% (65% risk reduction) and the observed annual major bleeding rate was 0% (100% risk reduction). CONCLUSIONS Patients with RS undergoing LAAO showed similar safety outcomes to patients without RS, with a significant reduction in stroke/transient ischemic attack and major bleeding events during follow-up. Adequately powered controlled trials are needed to further investigate the use of LAAO in RS patients.

Item Type:

Journal Article (Original Article)

UniBE Contributor:

Meier, Bernhard

ISSN:

1885-5857

Publisher:

Elsevier

Language:

English

Submitter:

Luana Cauto

Date Deposited:

13 Feb 2020 15:59

Last Modified:

13 Feb 2020 15:59

Publisher DOI:

10.1016/j.rec.2019.02.013

PubMed ID:

31036510

Uncontrolled Keywords:

Anticoagulación oral crónica Anticoagulant therapy Atrial fibrillation Cierre percutáneo de la orejuela izquierda Fibrilación auricular Ictus isquémico Ischemic stroke Left atrial appendage occlusion

BORIS DOI:

10.7892/boris.139334

URI:

https://boris.unibe.ch/id/eprint/139334

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