Percutaneous Left Atrial Appendage Occlusion Yields Favorable Neurological Outcomes in Patients with Non-Valvular Atrial Fibrillation

Abstract

We sought to determine neurological outcomes following stroke in patients with left atrial appendage occlusion (LAAO) or non-vitamin K antagonist oral anticoagulant (NOAC) treatment for non-valvular atrial fibrillation (NVAF). Left atrial appendage closure significantly reduced stroke severity and lowered the risk of disabling stroke at 12 months post-event compared to NOAC after adjusting for multiple demographic and cardiovascular risk factors (odds ratio, 0.23; 95% confidence interval, 0.07-0.71; p=0.01). Thus, LAAO may

Efficacy and safety of left atrial appendage closure compared with oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials and propensity-matched studies

“…Therefore, it seems plausible that only the study with the longest follow-up (29) and the one with the largest population appraised (16) were able to show a significant reduction in stronger but rarer endpoints such as death, which usually need longer follow-up to enlighten substantial difference in the treating groups. Moreover, as suggested by previous findings, this net benefit in mortality may be also related to the more favorable neurological outcomes after ischemic cerebrovascular event in LAAC patients rather than patients on OAC (30). Similar conclusions could be made regarding the reduction of major bleedings shown in our metanalysis in the LAAC group.…”

Comparison of the effects of left atrial appendage closure and oral anticoagulants in preventing stroke in patients with non-valvular atrial fibrillation

“…According to reports, about 90% of the thrombus in NVAF patients is formed in the left atrial appendage, but the etiology of thrombosis in the left atrial appendage is not clear. [6,7] Therefore, the focus of stroke prevention in NVAF patients is how to prevent thrombosis, which is what we often call anticoagulation therapy. Although oral anticoagulants (OA) are currently the standard plan to prevent stroke in NVAF patients, due to various reasons such as bleeding risk, compliance, and cost, especially elderly patients with atrial fibrillation have poor compliance with anticoagulants.…”

“…The formation of thrombus is the link that causes non-valvular atrial fibrillation (NVAF) to become a major risk cause of stroke. According to reports, about 90% of the thrombus in NVAF patients is formed in the left atrial appendage, but the etiology of thrombosis in the left atrial appendage is not clear [6,7] . Therefore, the focus of stroke prevention in NVAF patients is how to prevent thrombosis, which is what we often call anticoagulation therapy.…”