Open AccessPercutaneous left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation
Author(s) -
Hans-Christoph Diener,
Ulf Landmesser
Publication year - 2020
Publication title -
future neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.419
H-Index - 32
eISSN - 1748-6971
pISSN - 1479-6708
DOI - 10.2217/fnl-2020-0001
Subject(s) - medicine , atrial fibrillation , stroke (engine) , cardiology , percutaneous , randomized controlled trial , occlusion , gastrointestinal bleeding , surgery , mechanical engineering , engineering
Patients with atrial fibrillation (AF) have a fivefold higher risk of stroke than persons in sinus rhythm. Effective stroke prevention is achieved with oral anticoagulants such as vitamin K antagonists or nonvitamin K oral anticoagulants. An alternative for stroke prevention in patients with AF is the closure of the left atrial appendage (LAA) with a percutaneously applied closure system. The two large randomized studies PROTECT-AF and PREVAIL failed to show superiority of LAA closure over anticoagulation in patients with AF. Meta-analyses of studies and registries, however, suggest that LAA closure has particular advantages with regard to the reduction of severe bleeding complications. Currently, several prospective randomized studies are being conducted in different patient populations to evaluate the benefit of LAA closure in comparison to standard of care. Currently, LAA closure is recommended in patients after intracranial hemorrhage, with advanced renal failure, after severe gastrointestinal bleeding, in patients with a high risk of recurrent ischemic stroke and elderly patients with high risk of bleeding and falling.