The Left Atrial Appendage: Target for Stroke Reduction in Atrial Fibrillation
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Key result
Left atrial appendage exclusion provides a viable alternative to lifelong anticoagulation for stroke prevention in patients with atrial fibrillation, with newer devices showing high closure rates.
Why the study?
Does left atrial appendage exclusion prevent stroke in patients with atrial fibrillation compared to anticoagulation?
Population
Patients with atrial fibrillation at risk of stroke
Comparison
Left atrial appendage exclusion using… vs Anticoagulation
Design
Review
Authors
Discussion
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Member takes
Implication
May warrant consideration in anticoagulation-intolerant AF patients; leaves open need for RCTs versus NOACs.
Structured PICO
Does left atrial appendage exclusion prevent stroke in patients with atrial fibrillation compared to anticoagulation?
P
Population
Patients with atrial fibrillation at risk of stroke
I
Intervention
Left atrial appendage exclusion using percutaneous (WATCHMAN), hybrid (LARIAT), or epicardial surgical devices (AtriClip, TigerPaw)
C
Comparator
Anticoagulation (warfarin or novel oral anticoagulants)
O
Outcome
Stroke preventionhard clinical
Left atrial appendage exclusion, particularly via epicardial devices like AtriClip, offers a promising and potentially safer alternative to lifelong anticoagulation for stroke prevention in patients with atrial fibrillation.
Limitations
- High rates of incomplete occlusions with older surgical techniques
- Safety concerns and complications associated with some percutaneous and hybrid devices such as LARIAT and TigerPaw
- Need for further well-powered randomized controlled trials comparing newer LAA exclusion devices to anticoagulation
Cite This Study
Ramlawi et al. (2015) conducted a review in Atrial Fibrillation. Left Atrial Appendage (LAA) Exclusion vs. Anticoagulation was evaluated. Left atrial appendage exclusion provides a viable alternative to lifelong anticoagulation for stroke prevention in patients with atrial fibrillation, with newer devices showing high closure rates.
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