Oral anticoagulation and left atrial appendage closure: a new strategy for recurrent cardioembolic stroke.
Eur J Neurol. 2018 Dec 26;:
Authors: Masjuan J, Salido L, DeFelipe A, Hernández-Antolín R, Fernández-Golfín C, Cruz-Culebras A, Matute C, Vera R, Pérez-Torre P, Zamorano JL
BACKGROUND: There are no recommendations regarding how to treat cardioembolic recurrent strokes when patients are well anticoagulated. We evaluated the safety and efficacy of combining oral anticoagulation (OAC) with percutaneous left atrial appendage closure (LAAC) in well anticoagulated atrial fibrillation (AF) patients with recurrent strokes.
METHODS: In an explorative, prospective, observational study, LAAC was performed in AF patients with at least 2 ischemic strokes in the previous year, despite good anticoagulation using the Amplatzer Cardiac Plug or Amulet device. We recorded age, type of AF, CHA2 DS2 -VASC and HASBLED scores, types of OAC and risk factors. After closure, treatment with aspirin 100 mg/day was continued for 3 months in combination with indefinite OAC. Clinical status, recurrent embolisms and bleeding complications were recorded during follow-up.
RESULTS: Nineteen patients were included (mean age: 72.1±9.6 years; mean CHA2 DS2 Vasc: 5.3±1.48; mean number of previous strokes: 2.78±1.15). Thirteen had spontaneous echocardiographic contrast and all had dilatation of the LA. Eighteen patients had a multilobulated LAA, 17 with ‘chicken wing’ morphology and 1 patient had an LAA thrombus. There were no complications during the procedure. Only one patient had a transient ischemic attack and no major bleeding occurred during a mean follow-up of 17.4±11.5months.
CONCLUSIONS: Combination therapy with indefinite OAC plus LAAC in AF patients with recurrent strokes despite good anticoagulation should be considered in order to prevent a new stroke. This article is protected by copyright. All rights reserved.
PMID: 30586229 [PubMed – as supplied by publisher]