Synapse
⌘+K
Synapse
PulseExploreClubsResearchersJournals
Instagram
HomeClubsExplore
March 10, 2023CJC OpenOpen Access

Left atrial appendage closure in patients with nonvalvular AF and prior ICH resulted in an annualized stroke/TIA rate of 1.8%, which was lower than the predicted rate of 7.0%.

View Full Paper
Ask AI
Bookmark
Share

Why the study?

OAC is relatively contraindicated after ICH if the cause cannot be eliminated, leaving AF patients at high risk of thromboembolism, making endovascular LAAC a potential alternative.

Does endovascular left atrial appendage closure reduce the rate of stroke or TIA compared to predicted rates in patients with nonvalvular atrial fibrillation and prior intracranial hemorrhage?

Population

138 consecutive ICH patients with nonvalvular AF and high stroke risk

Comparison

Observed stroke/TIA rates post-LAAC vs CHA2DS2-VASc-predicted event rates

Design

Retrospective single-centre analysis

Follow-up

Mean 14.7 ± 13.7 months

Key result

Left atrial appendage closure in patients with nonvalvular AF and prior ICH resulted in an annualized stroke/TIA rate of 1.8%, which was lower than the predicted rate of 7.0%.

Authors

TGThomas GilhoferTNThomas NestelbergerMKMehima Kang

Discussion

Loading...

Member takes

Overview

LAAC may support stroke prevention in AF with prior ICH; leaves open confirmation in randomized trials before practice change.

Key Points

  • This analysis aims to evaluate the effectiveness of left atrial appendage closure (LAAC) for stroke prevention in atrial fibrillation patients with a history of intracranial hemorrhage.
  • Retrospective single-centre analysis of 138 patients with nonvalvular AF and prior ICH who underwent LAAC from 2010 to 2022.
  • Comparison of observed stroke/transient ischemic attack (TIA) rates with predicted rates based on CHA2DS2-VASc scores.
  • Evaluation of procedural success, complications, and follow-up data.
  • Procedural success rate was 98.6% with a complication rate of 3.6% and no periprocedural death, stroke, or TIA.
  • At mean follow-up of 14.7 months, 2 strokes (1.4%) and 1 TIA (0.7%) occurred, with an annualized observed stroke/TIA rate of 1.8%, significantly lower than the predicted rate of 7.0% (95% CI: 4.8%-9.2%).
  • Device-related thrombus was confirmed in 0.7% of patients, treated with oral anticoagulation without complications.

Study Design

Type

Cohort (n=138)

Multicenter

No

Structured PICO

Does endovascular left atrial appendage closure reduce the rate of stroke or TIA compared to predicted rates in patients with nonvalvular atrial fibrillation and prior intracranial hemorrhage?

P
Population
138 patients (mean age 76.1 years) with nonvalvular atrial fibrillation and prior intracranial hemorrhage who underwent left atrial appendage closure, followed for a mean of 14.7 months.
E
Exposure
Endovascular left atrial appendage closure (LAAC), followed by short-term dual antiplatelet therapy (1-6 months) and then aspirin alone for a minimum of 6 months in 86.2% of patients.
C
Comparator
Predicted event rate based on patients' CHA2DS2-VASc scores (no active control group).
O
Outcome
Observed stroke/transient ischemic attack (TIA) rate compared with the predicted event rate based on CHA2DS2-VASc scores.hard clinical

Main Result

Absolute Event Rate: 1.8% vs 7%

Endovascular left atrial appendage closure is associated with a lower-than-predicted rate of stroke and TIA in patients with nonvalvular atrial fibrillation and prior intracranial hemorrhage, offering a feasible alternative to oral anticoagulation.

Cite This Study

Gilhofer et al. (2023) conducted a cohort in Nonvalvular atrial fibrillation and prior intracranial hemorrhage (n=138). Endovascular left atrial appendage closure (LAAC) vs. Predicted event rate based on CHA2DS2-VASc scores was evaluated on Annualized stroke/TIA rate. Left atrial appendage closure in patients with nonvalvular AF and prior ICH resulted in an annualized stroke/TIA rate of 1.8%, which was lower than the predicted rate of 7.0%.

synapsesocial.com/papers/6a5f2c2c531077db68af396ehttps://doi.org/10.1016/j.cjco.2023.03.004
View Full Paper
Ask AI
Bookmark
Share

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Left Atrial Appendage Closure in Patients with Atrial Fibrillation and Acute Ischemic Stroke Despite Anticoagulation2023
  2. 2Left atrial appendage closure in patients with atrial fibrillation and acute ischaemic stroke despite anticoagulation2024
  3. 3Left atrial appendage closure for patients with atrial fibrillation at high intracranial haemorrhagic risk2024 · 6 citations
  4. 4Left atrial appendage closure in atrial fibrillation patients with prior major bleeding or ineligible for oral anticoagulation2019 · 7 citations
  5. 5Oral anticoagulation and left atrial appendage closure: a new strategy for recurrent cardioembolic stroke2018 · 29 citations