Left atrial appendage closure device implantation in patients at very high risk for stroke

Hutt, Erika; Wazni, Oussama; Kaur, Simrat; Saliba, Walid; Tarakji, Khaldoun G.; Kapadia, Samir; López-Aguilera, José; Barakat, Amr F.; Abdallah, Mouin; Jaber, Wael A.; Rasmussen, Peter A.; Hussain, Sarah K.; Uchino, Ken; Wisco, Dolora; Lindsay, Bruce D.; Kanj, Mohamed; Hussein, Ayman A.

doi:10.1016/j.hrthm.2019.07.011

Cited by 11 publications

(11 citation statements)

References 8 publications

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“…Hence, it would be reasonable to propose that LAAO devices lead to a similar if not better outcome when it comes to stroke prevention compared to OAC. Numerous other studies also support this argument [8,13,14]. To date, the most aggressively evaluated LAAO device is the Watchman device.…”

Section: Figure 1: Safety Concerns With Laao and Oacmentioning

confidence: 88%

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Comparison Between Oral Anticoagulation and Left Atrial Appendage Occlusion in the Prevention of Stroke With Regard to Non-Valvular Atrial Fibrillation

Sandhu¹,

Aftab²,

Anthony³

et al. 2020

Cureus

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In the past, the most common type of atrial fibrillation leading to stroke was valvular; this was predominantly due to the prevalence of rheumatic fever, but with the advent of better-hospitalized care, the cases of valvular atrial fibrillation declined. In recent years, there has been an increase in cases of stroke due to non-valvular atrial fibrillation. Stasis of blood in the left atrial pouch leads to coagulation and thrombi formation, which may lead to stroke. Oral medication or mechanical intervention can prevent thrombi formation. Both oral anticoagulation and left atrial appendage occlusion (LAAO) have been compared to see which has better outcomes. It was observed that LAAO has greater efficacy, but with time throughout a couple of years, no considerable difference was seen when compared to warfarin. Most of the long-term randomized controlled trials have been performed with the Watchman ® device. Although the Lariat and Amplatzer LAAO devices have also shown favorable outcomes, there is still a deficiency when it comes to trials of high-quality evidence using these devices as an intervention. Dual therapy with both of these approaches showed a decline in the count of major bleeding episodes on follow-up. Overall, albeit both methods have proven useful, LAAO has a slight advantage in efficacy and leads to less hemorrhagic events.

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Section: Figure 1: Safety Concerns With Laao and Oacmentioning

confidence: 88%

“…For these patients, LAAO has emerged as a nonpharmacological alternative for the prevention of stroke [6,7]. The two devices most commonly used in clinical practice are the Watchman® and Amulet® (Amplatzer) devices, but randomized studies are only available for the Watchman device [8].…”

Section: Introductionmentioning

confidence: 99%

Comparison Between Oral Anticoagulation and Left Atrial Appendage Occlusion in the Prevention of Stroke With Regard to Non-Valvular Atrial Fibrillation

Sandhu¹,

Aftab²,

Anthony³

et al. 2020

Cureus

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“…Except for one study by Urena et al [ 9 ] and the high-risk population of Hutt et al [ 10 ], the thromboembolic risk in the Austrian LAAC registry, as predicted by the CHA 2 DS 2 -VASc score (median 5) or CHADS 2 score (median 3), was higher than in previous studies, which report a median CHA 2 DS 2 -VASc score of 4 [ 3 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] or a median CHADS 2 score of 2 [ 18 , 19 ]. The bleeding risk assessed by the HAS-BLED score was comparable to previous literature (median 3) [ 13 , 14 , 15 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Indications and Outcome in Patients Undergoing Left Atrial Appendage Closure—The Austrian LAAC Registry

Zweiker

Sieghartsleitner

Fiedler

et al. 2020

JCM

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Background: Complete real-world data on the indications and outcomes of left atrial appendage closure (LAAC) outside of clinical trials are rare. In this study, we stratified patients undergoing LAAC by indication groups. Methods: This analysis of the national multicentre Austrian LAAC Registry comprised all patients that underwent LAAC up until 2018 at the currently active centres in Austria. The baseline characteristics, procedural details and outcomes between the following indication groups were compared: bleeding as an indication for LAAC (“bleeding” group) vs. thromboembolism despite oral anticoagulation (OAC; “thromboembolism” group) vs. an intolerance to OAC for reasons other than the above (“other” group). Results: The analysis included 186 patients, with 59.7% in the “bleeding” group, 8.1% in the “thromboembolism” group and 32.2% in the “other” group. The CHADS2 score was the highest in the “thromboembolism” group and the HAS-BLED score was the highest in the “bleeding” group. The procedural outcomes were similar between groups (implantation success, 97.3%), with major complications occurring in 7.0% of patients. One-year survival free from stroke, bleeding or LAAC-associated hospitalisation was 83.9%, 90.0% and 81.4% in the “bleeding”, “thromboembolism” and “other” groups, respectively (p = 0.891). Conclusions: In routine clinical practice, LAAC was used in a heterogeneous patient population with atrial fibrillation (AF) and contraindication, inefficacy or intolerance to OAC. The long-term outcome was favourable in all groups.

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“…53 Wazni and colleagues recently reported the feasibility and safety of WATCHMAN device implantation in 104 consecutive patients with CHADS2VASC > 5. 54 The residual annual stroke risk was 2.8% following WATCHMAN implant, compared to a 4% annual estimated risk of stroke on VKA. It is unclear to what extent residual stroke risk in patients with AF on OAC is secondary to noncardioembolic sources of stroke.…”

Section: Elevated Residual Stroke Riskmentioning

confidence: 94%

“…Many patients with AF and higher stroke risk, particularly those with permanent AF or concomitant HF, have significant residual stroke risk despite anticoagulation . Wazni and colleagues recently reported the feasibility and safety of WATCHMAN device implantation in 104 consecutive patients with CHADS2VASC > 5 . The residual annual stroke risk was 2.8% following WATCHMAN implant, compared to a 4% annual estimated risk of stroke on VKA.…”

Section: Laac and Doac In Unique Subgroupsmentioning

confidence: 99%

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

Black‐Maier

Piccini

Granger

2019

Cardiovasc electrophysiol

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Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and confers a fivefold increased risk for stroke. Cardioembolic stroke secondary to AF is a devastating event, but is largely preventable with appropriate oral anticoagulation (OAC). The PROTECT and PREVAIL trials demonstrated that the WATCHMAN left atrial appendage closure (LAAC) device in combination with short‐term warfarin therapy is noninferior to long‐term warfarin with respect to a composite endpoint of stroke, cardiovascular death, and systemic embolism. Importantly, the WATCHMAN confers a significant reduction in life‐threatening bleeding compared to OAC. Although direct‐acting oral anticoagulant (DOAC) are superior to warfarin in eligible patients, several important AF populations exist in whom left atrial appendage (LAA) closure may be preferable to DOAC. Populations warranting strong consideration of LAAC include patients with contraindications to DOAC, end‐stage renal disease, prior intracranial hemorrhage, recurrent gastrointestinal bleeding, and patients undergoing transcatheter aortic valve replacement or left atrial electrical isolation. Device‐related thrombosis is an important complication of LAAC, and DOAC may be preferential to warfarin for prevention and treatment of this complication remains unexplored. Prospective clinical trials comparing DOAC to LAAC in these unique populations are either ongoing or needed.

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Left atrial appendage closure device implantation in patients at very high risk for stroke

Cited by 11 publications

References 8 publications

Comparison Between Oral Anticoagulation and Left Atrial Appendage Occlusion in the Prevention of Stroke With Regard to Non-Valvular Atrial Fibrillation

Comparison Between Oral Anticoagulation and Left Atrial Appendage Occlusion in the Prevention of Stroke With Regard to Non-Valvular Atrial Fibrillation

Indications and Outcome in Patients Undergoing Left Atrial Appendage Closure—The Austrian LAAC Registry

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

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