November 13, 2018Journal of Cardiovascular Medicine

Nonvalvular atrial fibrillation in high-hemorrhagic-risk patients: state of the art of percutaneous left atrial appendage occlusion

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Why the study?

Does percutaneous left atrial appendage occlusion prevent thromboembolic events and reduce hemorrhagic events in patients with nonvalvular atrial fibrillation and high hemorrhagic risk compared to oral anticoagulant therapy?

Structured PICO

Population

Patients with nonvalvular atrial fibrillation at increased stroke risk and high or prohibitive hemorrhagic risk

Intervention

Percutaneous left atrial appendage occlusion (LAAO) using devices such as WATCHMAN, AMPLATZER cardiac plug, or Amulet

Comparator

Oral anticoagulant therapy

Outcome

Thromboembolic events and hemorrhagic events

Percutaneous left atrial appendage occlusion represents a viable, non-inferior alternative to oral anticoagulation for stroke prevention in atrial fibrillation patients with high bleeding risk.

Implication

May support LAAO consideration in high-bleeding-risk AF; leaves open prospective randomized confirmation.

Abstract

: Atrial fibrillation is the most common cardiac arrhythmia and its prevalence is constantly increasing. The main complications related to atrial fibrillation are death and major stroke. Oral anticoagulant therapy is the cornerstone of management of atrial fibrillation patients at increased stroke risk. Unfortunately, a significant proportion of patients do not receive adequate anticoagulant therapy due to increased or prohibitive hemorrhagic risk. The observation that most thrombi are generated in the left atrial appendage (LAA) had led to the consideration of surgical or percutaneous occlusion as an alternative. During recent years, the WATCHMAN percutaneous occlusion device has proven to be not inferior to anticoagulant therapy for the prevention of thromboembolic events, with the added benefit of a lower rate of hemorrhagic events. Numerous data showed the same results for the AMPLATZER cardiac plug and Amulet devices. Left atrial appendage occlusion (LAAO) often represents the only therapeutic strategy in this group of patients. We describe the current state of the art of percutaneous LAAO in atrial fibrillation patients with a high hemorrhagic risk.