Does left atrial appendage closure added to oral anticoagulation reduce stroke and bleeding events in patients with atrial fibrillation-related ischemic stroke despite oral anticoagulation?
In patients with ischemic stroke despite oral anticoagulation, adding left atrial appendage closure may reduce fatal bleeding and fatal or disabling stroke compared to oral anticoagulation alone.
BACKGROUND: In patients with atrial fibrillation-related ischemic stroke despite oral anticoagulation (AFIDA), left atrial appendage closure (LAAC) may be an additional strategy to prevent further stroke events. METHODS AND RESULTS: scores. Three-year cumulative incidence rates of ischemic stroke and major bleeding were comparable between the OAC alone and +LAAC groups (15.2% vs. 14.5% log-rank P=0.75 and 23.4% vs. 5.3% log-rank P=0.38, respectively), whereas those of fatal or disabling stroke and fatal bleeding were lower in the +LAAC than OAC alone group (3.4% vs. 14.7% log-rank P=0.06 and 0% vs. 6.0% log-rank P=0.03, respectively). Results of propensity score-matched and subgroup analyses were largely consistent with those of the main analysis. Notably, fatal bleeding occurred only in patients switched to aggressive OAC. CONCLUSIONS: LAAC may potentially prevent fatal or disabling stroke and fatal bleeding in patients with AFIDA. These hypothesis-generating findings support the need for randomized controlled trials.
Chatani et al. (Fri,) studied this question.
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