Strategies for Stroke Prevention in Vulnerable Patients with Atrial Fibrillation

A randomized trial demonstrated noninferiority of left atrial appendage closure and direct oral anticoagulation.

For patients with nonvalvular atrial fibrillation (AF), left atrial appendage closure (LAAC) with a percutaneous device is noninferior to oral anticoagulation with a vitamin K antagonist (VKA) and reduces risk for hemorrhagic stroke. As newer direct oral anticoagulants (DOACs) also lower the risk for hemorrhagic stroke more than VKA, researchers in a randomized, open-label, multicenter trial compared DOACs (apixaban, 96%) with two LAAC devices in 402 patients with AF (mean age, 73; 34% women).

Patients were at moderate-to-high risk for embolism (CHA₂DS₂-VASc mean score, 4.7) and bleeding (HAS-BLED mean score, 3) and were followed for a median of 21 months. The primary composite endpoint — stroke or transient ischemic attack, systemic embolis…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)