LAAO plus lifelong OAC in high-ischemic risk patients showed no difference in survival free from death, MACE, or major bleeding compared to LAAO for primary prevention (P=0.19).
Cohort (n=102)
No
Does LAAO combined with lifelong OAC improve outcomes in atrial fibrillation patients with ischemic events or LAA sludge despite OAC compared to LAAO for primary prevention?
A hybrid approach of LAAO and lifelong OAC appears safe and effective for high-risk AF patients who fail OAC therapy, with outcomes comparable to those undergoing LAAO for primary prevention.
p-value: p=0.19
Background: The role of left atrial appendage occlusion (LAAO) for atrial fibrillation patients that during oral anticoagulant therapy (OAC) suffer from ischemic events or present LAA sludge, and the best postinterventional anticoagulant regimen, need to be defined. We present our experience with a hybrid approach of LAAO+ lifelong OAC therapy in this cohort of patients. Methods: Out of 425 patients treated with LAAO, 102 underwent LAAO because, despite OAC, suffered from ischemic events or presented with LAA sludge. Patients without high bleeding risk were discharged with the aim of maintaining lifelong OAC. This cohort was then matched to a population who underwent LAAO in primary ischemic events prevention. The primary endpoint was the composite of all-cause death and major adverse cardiovascular events consisting of ischemic stroke, systemic embolism (SE), and major bleeding. Results: = .19). Conclusions: In this high-ischemic risk cohort, LAAO + OAC seem a long-term safe and effective therapeutical approach, with no difference in the survival free from the primary endpoint according to the indication for LAAO in a matched cohort.
Margonato et al. (Sat,) conducted a cohort in Atrial fibrillation with ischemic events or LAA sludge during OAC (n=102). Left atrial appendage occlusion (LAAO) + lifelong OAC vs. LAAO for primary ischemic events prevention was evaluated on Composite of all-cause death and major adverse cardiovascular events consisting of ischemic stroke, systemic embolism (SE), and major bleeding (p=0.19). LAAO plus lifelong OAC in high-ischemic risk patients showed no difference in survival free from death, MACE, or major bleeding compared to LAAO for primary prevention (P=0.19).