Left atrial appendage closure: a new strategy for cardioembolic events despite oral anticoagulation.
| Title: | Left atrial appendage closure: a new strategy for cardioembolic events despite oral anticoagulation. |
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| Authors: | Falasconi G; Unit of Clinical Cardiology, IRCCS San Raffaele Hospital, Milan, Italy - giuliofalasconi@gmail.com.; Vita-Salute San Raffaele University, Milan, Italy - giuliofalasconi@gmail.com.; Gaspardone C; Unit of Clinical Cardiology, IRCCS San Raffaele Hospital, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy.; Godino C; Unit of Clinical Cardiology, IRCCS San Raffaele Hospital, Milan, Italy.; Gaspardone A; Division of Cardiology, S. Eugenio Hospital, Rome, Italy.; Radinovic A; Department of Arrhythmology and Cardiac Electrophysiology, IRCCS San Raffaele Hospital, Milan, Italy.; Pannone L; Unit of Clinical Cardiology, IRCCS San Raffaele Hospital, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy.; Leo G; Vita-Salute San Raffaele University, Milan, Italy.; Posteraro GA; Division of Cardiology, S. Eugenio Hospital, Rome, Italy.; Slavich M; Unit of Clinical Cardiology, IRCCS San Raffaele Hospital, Milan, Italy.; Melillo F; Unit of Cardiovascular Imaging, IRCCS San Raffaele Hospital, Milan, Italy.; Marzi A; Department of Arrhythmology and Cardiac Electrophysiology, IRCCS San Raffaele Hospital, Milan, Italy.; D'Angelo G; Department of Arrhythmology and Cardiac Electrophysiology, IRCCS San Raffaele Hospital, Milan, Italy.; Limite LR; Department of Arrhythmology and Cardiac Electrophysiology, IRCCS San Raffaele Hospital, Milan, Italy.; Frontera A; Department of Arrhythmology and Cardiac Electrophysiology, IRCCS San Raffaele Hospital, Milan, Italy.; Brugliera L; Unit of Physical Rehabilitation, IRCCS San Raffaele Hospital, Milan, Italy.; Agricola E; Vita-Salute San Raffaele University, Milan, Italy.; Unit of Cardiovascular Imaging, IRCCS San Raffaele Hospital, Milan, Italy.; Margonato A; Unit of Clinical Cardiology, IRCCS San Raffaele Hospital, Milan, Italy.; Vita-Salute San Raffaele University, Milan, Italy.; Della Bella P; Department of Arrhythmology and Cardiac Electrophysiology, IRCCS San Raffaele Hospital, Milan, Italy.; Mazzone P; Department of Arrhythmology and Cardiac Electrophysiology, IRCCS San Raffaele Hospital, Milan, Italy. |
| Source: | Panminerva medica [Panminerva Med] 2023 Jun; Vol. 65 (2), pp. 227-233. Date of Electronic Publication: 2021 Oct 19. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Panminerva Medica Country of Publication: Italy NLM ID: 0421110 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1827-1898 (Electronic) Linking ISSN: 00310808 NLM ISO Abbreviation: Panminerva Med Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Turin : Panminerva Medica |
| MeSH Terms: | Stroke*/prevention & control ; Stroke*/complications ; Atrial Appendage*/surgery ; Atrial Fibrillation*/complications ; Atrial Fibrillation*/diagnosis ; Atrial Fibrillation*/drug therapy; Aspirin/adverse effects ; Hemorrhage/chemically induced ; Hemorrhage/complications ; Anticoagulants/adverse effects ; Humans ; Retrospective Studies ; Treatment Outcome |
| Abstract: | Background: Patients with non-valvular atrial fibrillation (nvAF) who experienced a cardioembolic (CE) event despite adequate oral anticoagulation (OAC) are at high risk of recurrence, and further prevention strategies are deemed necessary. The present study aimed to evaluate the safety and efficacy of off-label use of left atrial appendage closure (LAAC) in this subset of patients.; Methods: Seventy-five consecutive patients with nvAF who experienced a CE event despite adequate OAC therapy were retrospectively enrolled from two Italian centers. Patients were divided according to the treatment strategy following the index event: DOAC group (49 patients who continued OAC therapy with DOACs) and LAAC group (26 patients who underwent LAAC procedure). 1:1 propensity-score matching between the two groups was performed. LAAC group was made up of two subgroups according to the post-procedural pharmacological regimen: 1) dual antiplatelet therapy (DAPT) for 3 months followed by indefinite single antiplatelet therapy (LAAC+SAPT); or 2) aspirin plus DOAC for 3 months followed by indefinite DOAC therapy (LAAC+DOAC). The primary endpoint was a composite of CE event, major bleeding, or procedure-related major complication.; Results: During a median follow-up of 3.4 years (IQR: 2.0-5.3), LAAC was a predictor of primary endpoint-free survival (HR=0.28, 95% CI: 0.08-0.97; P=0.044); within LAAC group, no procedure-related major complication occurred. Moreover, a trend toward a lower rate of both CE events and major bleedings was observed in LAAC group, particularly in the subgroup LAAC+DOAC.; Conclusions: LAAC is a reasonable therapeutic option in nvAF patients who suffered a CE event despite adequate OAC therapy. |
| Substance Nomenclature: | R16CO5Y76E (Aspirin); 0 (Anticoagulants) |
| Entry Date(s): | Date Created: 20211019 Date Completed: 20230711 Latest Revision: 20230718 |
| Update Code: | 20260130 |
| DOI: | 10.23736/S0031-0808.21.04446-3 |
| PMID: | 34664480 |
| Database: | MEDLINE |
Journal Article