高龄非瓣膜病心房颤动患者抗栓治疗调查

目的调查华东医院心内科≥80岁非瓣膜病心房颤动患者临床特征及抗血栓药物治疗的情况,了解用药现状。方法调查≥80岁非瓣膜病房颤患者84例,对其危险因素等临床特征及抗血栓药物使用情况进行分析。结果非瓣膜性房颤的病因以冠心病、高血压病、肺源性心脏病、甲状腺功能亢进、孤立性房颤及扩张型心肌病为主。84例患者中,绝大多数合并多种危险因素,其中应用华法林者只有6例（7．1％）,应用阿司匹林者56例（66．7％）,其他抗血小板药物7例（8．3％）,未应用抗血栓药物15例（17．9％）。结论高龄非瓣膜病房颤患者华法林应用率低,抗血小板药使用率高。     

62例高龄病例心房颤动的临床分析

目的 分析高龄病例心房颤动(AF)的病因、房颤类型、左房内径.方法 对62例≥80岁的老年人房颤住院患者的临床资料进行回顾性分析.结果 患者中阵发性、持续性和持久性房颤分别为21例(33.87％)、14例(22.58％)、27例(43.55％).冠心病是最常见的病因,其次是高血压、瓣膜退行性病变和电解质紊乱.阵发性房颤与持续性房颤和永久性房颤相比,左房内径均小于后两者(P值均＜0.05).62例中发生动脉栓塞22例(35.48％),脑卒中20例(32.26％).有21例未接受任何抗凝治疗.结论 高龄患者房颠常见原因是冠心病和高血压病,脑卒中是其重要并发症,抗血栓治疗以抗血小板治疗为主,对高龄房颤患者抗栓治疗应该谨慎.     

北京城区医院非瓣膜性心房颤动患者阿司匹林剂量对预防缺血性脑卒中疗效的影响

心房颤动(房颤)是缺血性脑卒中的独立危险因素,非瓣膜性房颤患者脑卒中患病危险是无房颤者的5～6倍.抗凝和抗血小板治疗均为房颤患者预防脑卒中的重要措施,但预防效果抗凝治疗优于抗血小板治疗[1-2].我国房颤患者抗凝治疗率低,抗血小板治疗应用广泛,但阿司匹林剂量多在300 mg/d以下[3-5].国外临床试验结果显示,阿司匹林剂量低于325 mg/d不能显著降低脑卒中的危险.低剂量阿司匹林对房颤患者缺血性脑卒中的预防效果还需要随访研究证实.我们对非瓣膜性房颤患者阿司匹林服用剂量及对脑卒中的预防效果进行分析.     

心房颤动:控制心室率与转复并维持窦性心律?

心房颤动 (房颤 )是临床上最常见的持续性快速心律失常 ,虽然其本身并不具有致命性特点 ,但房颤患者可以有各种临床症状 ,生活质量下降 ,若产生心房附壁血栓可引起缺血性脑卒中 ,从而增加患者病死率。此外对针对房颤的抗心律失常药产生的副作用 ,也增加对房颤患者的危害。目前公认的房颤治疗策略包括①针对房颤发生的病因或诱因进行治疗 ;②恢复并维持窦性心律 (窦律 ,节律控制 ) ;③控制房颤时心室率 (心室率控制 ) ;④抗凝治疗预防动脉血栓栓塞事件。其中针对心律不整齐的节律控制和心室率控制究竟哪一个更优 ?作为首选多年来一直存有争议…     

心房颤动1533例病因及治疗策略变化分析

目的了解近8年心房颤动(简称房颤)的病因变化和治疗策略转变情况,为临床防治提供参考。方法回顾性分析1998年1月至2005年12月在重庆医科大学附属第二医院心血管内科治疗资料完整的房颤患者839例,与1990年1月至1997年12月的房颤患者694例为对照。结果(1)近年来高血压(34.3%)、冠心病(29.4%)已超过风心病(20.5%)成为房颤的主要病因,老年患者增多(60岁以上者占68.3%)。(2)阵发性房颤多采用复律治疗(51.4%),药物多为胺碘酮(67%)、心律平(24%)。(3)慢性房颤治疗以控制心室率(76%)为主,药物选择为洋地黄类(39%)、β-受体阻滞剂(36%)、钙拮抗剂(25%),有不足1/2的持续性房颤患者试行复律。(4)抗血栓治疗以抗血小板为主(77.9%),药物多为阿司匹林,抗凝治疗(华法林)占10.1%。结论近8年来房颤的病因主要为高血压、冠心病,治疗策略以控制心室率为主,对于存在血栓高危因素者应以抗凝治疗为主,目前还存在抗凝治疗强度及剂量不足,控制心室率治疗不规范等问题。     

75岁以上老年非瓣膜病性心房颤动患者抗凝治疗的临床分析

目的 了解老年非瓣膜病性心房颤动(房颤)患者的抗凝治疗现状及影响的因素。方法 纳入2020年1月至2021年9月于我院不同科室住院的75岁以上非瓣膜性房颤患者382例，其中心血管内科217例分布最多，根据出院时抗凝方案不同分为抗凝组260例及未抗凝组122例。对患者进行1年随访并记录出血、缺血性脑卒中及死亡事件的发生情况。分析影响老年房颤患者是否抗凝的相关因素。结果 抗凝组吸烟、饮酒、冠心病、出血史、肿瘤、抗血小板药物比例及HAS-BLED评分明显低于未抗凝组(P<0.05,P<0.01)。二元logistic回归分析显示，出血史(OR=0.320,95%CI:0.120～0.853,P=0.023)、肿瘤(OR=0.348,95%CI:0.139～0.869,P=0.024)、既往口服抗血小板药物(OR=0.095,95%CI:0.049～0.185,P=0.000)是影响老年房颤患者抗凝药物选择的相关因素。结论 出血史、肿瘤及既往口服抗血小板药物史可影响房颤患者出院时的选择。     

血栓栓塞的预防

血栓栓塞是心房颤动(房颤)的一个非常重要的并发症,也是房颤致残的一个重要原因。关于房颤血栓栓塞的预防,ACC/AHA/ESC房颤指南从危险分层,治疗策略和建议,抗血小板治疗和抗凝治疗,房颤复律的抗凝治疗几方面进行了阐述。本文对其中的关键点给予简要的解读。流行病学资料显示,非瓣膜病房颤患者,缺血性脑卒中和全身血栓栓塞的危险因素有:既往脑卒中、一过性缺血发作(TIA)、糖尿病、高血压病史、心力衰竭及高龄。其中既往脑卒中和TIA是脑卒中最强的独立预测因素。年龄也是脑卒中的独立预测因素,约半数房颤相关的脑卒中发生于75岁以上,也…     

老年非瓣膜病性心房纤颤患者抗血栓治疗现状分析

目的分析空军总医院老年非瓣膜病性心房纤颤（NVAF）患者抗血栓药物治疗现状及未抗凝治疗的原因。方法调查老年NVAF患者109例,对其病因、血栓栓塞危险因素、抗血栓药物应用情况及未应用华法林抗凝治疗原因进行分析。应用CHADS卒中风险评分表对NVAF患者进行血栓栓塞危险评估。结果91.6%患者接受了抗血栓治疗。符合抗凝治疗指征患者68例,仅38.2%接受了华法林治疗,57.4%进行了抗血小板治疗阿司匹林剂量为（87±15）mg/d,4.4%未进行任何抗血栓治疗。而其中NVAF呈阵发性者仅5.0%应用了华法林抗凝治疗。未抗凝治疗者54例,其中存在抗凝禁忌证12例（15.0%）;严重出血而停用1例（1.3%）,不能凝血监测2例（2.5%）;担心出血拒绝8例（10.0%）;阵发性心房纤颤未抗凝治疗20例（25.0%）;冠脉支架术后双重抗血小板治疗而未抗凝治疗3例（3.75%）;原因不明9例（11.3%）。结论老年NVAF患者抗血栓治疗中华法林应用率低,而且阵发性心房纤颤的华法林应用率更低,抗血小板治疗中阿司匹林剂量不足。     

胺碘酮在急性和慢性心房颤动中的应用进展

治疗急性心房颤动(房颤)可采取心室率控制和节律控制策略,对于慢性房颤,指南推荐控制心室率,对心室率控制不佳的患者可以使用胺碘酮治疗。胺碘酮尽管有一些心脏以外的不良反应,但是在房颤的节律控制和维持窦性心律方面均有重要应用。临床研究显示,胺碘酮比Ⅰ类抗心律失常药物更常用。     

大连市心房颤动门诊病例诊治现状分析

目的评价大连市心房颤动(房颤)患者门诊治疗情况。方法将441例房颤患者按就诊医院级别分为A、B、C3组,分析治疗现状。结果 (1)房颤的相关危险因素中高血压最常见(255例,57.8%),其次为冠心病(194例,44.0%)和心力衰竭(180例,40.8%)。(2)阵发性房颤占36.5%,余为慢性房颤,其中33.5%的阵发性房颤患者采用药物复律;47.2%的患者采用控制心室率治疗。81.2%的慢性房颤患者采用控制心室率治疗。(3)C组β受体阻滞剂的使用率(46.5%)低于另外两组(69.0%和69.6%),普罗帕酮的使用率(29.6%)高于另外两组(1.7%和0,均为P0.05)。(4)抗血栓治疗率A组为85.3%,B组为76.4%,C组为59.2%。(5)中药使用率为11.1%,C组使用率高于另外两组(P0.05)。结论门诊治疗尚存在抗心律失常治疗不规范,抗血栓治疗强度及剂量不足等问题。     

Retrospective investigation of hospitalised patients with atrial fibrillation in mainland China

OBJECTIVE: To evaluate the epidemiology and status of atrial fibrillation in China. METHODS: Retrospective analysis of hospital records of patients with a primary diagnosis of atrial fibrillation, discharged between January 1999 and December 2001. RESULTS: Data were analysed from 9297 patients (mean age 65.5 years) from 41 hospitals in mainland China. During the period studied, atrial fibrillation admissions (mean 7.9%) increased as a proportion of cardiovascular admissions. The distribution of atrial fibrillation increased with age. Causes and associated conditions were advanced age (58.1%), hypertension (40.3%), coronary heart disease (34.8%), heart failure (33.1%), rheumatic valvular disease (23.9%), idiopathic atrial fibrillation (7.4%), cardiomyopathy (5.4%) and diabetes (4.1%). Permanent atrial fibrillation accounted for almost half of the patients (49.5%), and paroxysmal and persistent atrial fibrillation the remainder (33.7% and 16.7%, respectively). Paroxysmal atrial fibrillation was treated mainly by rhythm control (56.4%). In 82.8% of patients with chronic atrial fibrillation, a rate-control strategy was used. The prevalence of stroke was 17.5%. In non-valvular atrial fibrillation, risk factors associated with stroke included advanced age, history of hypertension, coronary heart disease and type of atrial fibrillation. A total of 64.5% of patients received antithrombotic therapy, predominantly with antiplatelet agents. Patients managed with antiplatelet or anticoagulant drugs had a significantly lower stroke rate than those receiving neither treatment, but there was no significant difference between antiplatelet and anticoagulant agents. CONCLUSION: Most of the atrial fibrillation-related epidemiological factors in this population were similar to those reported in other countries. Antiplatelet and anticoagulant treatment both reduced stroke rate significantly.     

Atrial fibrillation and cardioembolic stroke

The most disabling consequence of atrial fibrillation (AF) is stroke. In the elderly, AF is the single most important cause of stroke. The risk of stroke is increased at least 6-fold in subjects with AF. Strokes in patients with AF are in general severe, associated with higher risk of fatality and prone to early and long-term recurrence. The cardiac origin of stroke can be strongly suspected by anamnesis, clinical examination and findings on neuroimaging. Paroxysmal AF is an important cause of brain embolism, that is often difficult to document. Risk factors for stroke in AF include: previous embolism (including previous transient ischaemic attack (TIA), or ischaemic stroke), age >65 years, structural cardiac disease, rheumatic or other significant valvular heart disease, valvular artificial prosthesis, hypertension, heart failure and significant left ventricular systolic dysfunction, diabetes and coronary disease. All AF patients with TIA or stroke have a formal indication for long-term anticoagulation. Only patients without risk factors or with contraindications to warfarin should be put on aspirin. Treating 1 000 patients with AF for 1 year with oral anticoagulants rather than aspirin would prevent 23 ischaemic strokes while causing 9 major bleedings. Despite its enormous preventive potential, oral anticoagulants are underused in AF, because treating physicians often have lack of knowledge about trials and guidelines, underestimate the benefits and overestimate the risks associated with continuous oral anticoagulation. The introduction of anticoagulants that do not need frequent control tests, such as ximelagatran, will increase the proportion of AF patients with risk factors for stroke who are anticoagulated. There is no evidence to support routine immediate anticoagulation in acute ischeamic stroke associated with AF.     

Stroke Event Rates and the Optimal Antithrombotic Choice of Patients With Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The risks of stroke or systemic embolism and major bleeding are considered similar between paroxysmal and sustained atrial fibrillation (AF), and warfarin has demonstrated superior efficacy to aspirin, irrespective of the AF type. However, with the advent of novel oral anticoagulants (NOACs) and antiplatelet agents, the optimal antithrombotic prophylaxis for paroxysmal AF remains unclear.We searched Medline, Embase, CENTRAL, and China Biology Medicine up to October week 1, 2015. Randomized controlled trials of AF patients assigned to NOACs, warfarin, or antiplatelets, with reports of outcomes stratified by the AF type, were included. A fixed-effects model was used if no statistically significant heterogeneity was indicated; otherwise, a random-effects model was used.Six studies of 69,990 nonvalvular AF patients with ≥1 risk factor for stroke were included. Postantithrombotic treatment, paroxysmal AF patients showed lower risks of stroke (risk ratio [RR], 0.72; 95% confidence interval [CI], 0.59–0.87), stroke or systemic embolism (RR, 0.74; 95% CI, 0.63–0.86), and all-cause mortality (RR, 0.75; 95% CI, 0.67–0.83), while the major bleeding risk was comparable (RR, 0.96; 95% CI, 0.85–1.08). We were unable to detect the superiority of anticoagulation over antiplatelets for paroxysmal AF (RR, 0.72; 95% CI, 0.43–1.23), while it was more effective than antiplatelets for sustained AF (RR, 0.42; 95% CI, 0.33–0.54). NOACs showed superior efficacy over warfarin and trended to show reduced major bleeding irrespective of the AF type.The AF type is a predictor for thromboembolism, and might be helpful in stroke risk stratification model in combination with other risk factors. With the appearance of novel anticoagulant and antiplatelet agents, the best antithrombotic choice for paroxysmal AF needs further exploration.     

Detection of paroxysmal atrial fibrillation or flutter in patients with acute ischemic stroke or transient ischemic attack by Holter monitoring

Background and purpose

Paroxysmal atrial fibrillation and flutter are strong risk factors for stroke. Due to high recurrence rate of ischemic events and given the benefit of oral anticoagulation over antiplatelet drugs, it is important to identify this arrhythmia. Unfortunately, paroxysmal AF or flutter is asymptomatic in majority and therefore, difficult to detect.

Methods

Consecutive patients presenting with symptoms of acute ischemic stroke or transient ischemic attack were included. All patients free of AF or flutter on presentation underwent 24 h Holter monitoring within 7 days of admission.

Results

Overall, fifty two (52) patients (mean age 59.51 ± 13.45 years) with acute stroke (80.8%) and TIA (19.8%) underwent 24 h Holter monitoring. Paroxysmal AF was detected in 3 cases (5.8%), all 3 patients had acute stroke and were older than age 60 years. Type of stroke was the only factor which was associated with greater risk of having paroxysmal AF or flutter, AF accounted for 50% cases (2 out of 4) of clinically suspected cardio embolic stroke.

Conclusion

Screening consecutive patients with ischemic stroke with routine Holter monitoring will identify new atrial fibrillation/flutter in approximately one in 17 patients. Older age and type of stroke are strongly associated with increased risk. By carefully selecting the patients, the detection rates could be further increased.     

心房颤动患者经导管主动脉瓣植入术后1年随访结果

目的探讨经导管主动脉瓣植入(TAVI)术前合并心房颤动(房颤)是否会对患者的预后产生影响。方法本研究为单中心回顾性研究。入选2016年5月至2020年11月于北部战区总医院住院并成功接受TAVI治疗且顺利出院的重度主动脉瓣狭窄患者115例。根据入选患者是否合并房颤将其分为房颤组(21例)及非房颤组(94例)。随访纳入患者的术后抗栓治疗情况及终点事件的发生情况, 终点事件为12个月的净不良心脑血管事件(NACCE), 包括心原性死亡、因心力衰竭再入院、非致死性心肌梗死、缺血性卒中及严重出血[出血学术研究联合会(BARC)定义的3～5型出血]。采用单因素logistic回归分析NACCE事件的相关因素。结果本研究共纳入115例成功接受TAVI并顺利出院的重度主动脉瓣狭窄患者, 年龄(73.8±6.9)岁, 男性63例, 其中21例(18.2%)在TAVI术前诊断为房颤。在术后抗栓治疗方面, 非房颤组患者中48.9%(46/94)接受了单药抗血小板治疗, 47.9%(45/94)接受了双联抗血小板治疗。房颤组患者中47.6%(10/21)使用抗凝药, 33.3%(7/21)接受了双联抗血小板...     

Antithrombotic therapy in atrial fibrillation and additional stroke/embolism risk factors. CORSurvey Study]

OBJECTIVES: To evaluate 1) how many patients with atrial fibrillation (AF) and heart failure were discharged from Austrian hospitals with antithrombotic therapy, 2) if the presence of risk factors for stroke/embolism (age > 65 years, arterial hypertension, diabetes, and previous stroke) influence the choice of antithrombotic therapy and if the presence of contraindications for oral anticoagulation (dementia, alcohol abuse) influence the choice of antithrombotic therapy, and 3) if there are differences among the types of departments in the use of antithrombotic therapy. PATIENTS: Included were 1566 patients (841 female, 725 male, mean age 76 years) with AF and heart failure. METHODS: At discharge, a questionnaire was completed including risk factors, contraindications for antithrombotic therapy, and antithrombotic medication. RESULTS: Oral anticoagulants (OAC) had 26% of the cases, acetyl salicylic acid (ASA) 31%, a combination of OAC and ASA 2%, and no antithrombotic therapy 41%. The risk factors age > 65 years, arterial hypertension, diabetes, and previous stroke did not influence the choice of antithrombotic therapy. Dementia but not alcohol abuse influenced the choice against OAC. The rate of OAC was higher in cardiological or cardiovascular rehabilitation clinics than in other departments. CONCLUSION: The results of this survey show that in medical practice the recommendations regarding antithrombotic therapy in atrial fibrillation are rarely considered, especially when additional risk factors are present.     

A review of the epidemiology of atrial fibrillation in sub‐Saharan Africa

This systematic review summarizes the data on the prevalence, risk factors, complications, and management of atrial fibrillation (AF) in sub‐Saharan Africa (SSA). Bibliographic databases were searched from inception to 31 May 2019, to identify all published studies providing data on AF in populations living in SSA. A total of 72 studies were included. The community‐based prevalence of AF was 4.3% and 0.7% in individuals aged ≥40 years and aged ≥70 years, respectively. The prevalence of AF ranged between 6.7% and 34.8% in patients with ischemic stroke, between 9.5% and 46.8% in those with rheumatic heart disease (RHD), between 5% and 31.5% in patients with dilated cardiomyopathy. The main risk factors for AF were hypertension, affecting at least one‐third of patients with AF, and valvular heart disease (12.3%‐44.4%) and cardiomyopathy (~20%). Complications of AF included heart failure in about two thirds and stroke in 10% to 15% of cases. The use of anticoagulation for stroke prevention was suboptimal. Rate control was the most frequent therapeutic strategy, used in approximately 65% to 95% of AF patients, with approximately 80% of them achieving rate control. The management of AF was associated with exorbitant cost. In conclusion, AF seems to have a higher prevalence in the general population than previously thought and is mostly associated with hypertension, cardiomyopathy, and RHD in SSA. It is associated with a high incidence of heart failure and stroke. The management of AF is suboptimal in SSA, especially with a low uptake of oral anticoagulation.     

Practice-level variation in warfarin use among outpatients with atrial fibrillation (from the NCDR PINNACLE program)

Warfarin is a complex but highly effective treatment for decreasing thromboembolic risk in atrial fibrillation (AF). We examined contemporary warfarin treatment rates in AF before the expected introduction of newer anticoagulants and extent of practice-level variation in warfarin use. Within the National Cardiovascular Data Registry Practice Innovation and Clinical Excellence program from July 2008 through December 2009, we identified 9,113 outpatients with AF from 20 sites who were at moderate to high risk for stroke (congestive heart failure, hypertension, age, diabetes, stroke score >1) and would be optimally treated with warfarin. Using hierarchical models, the extent of site-level variation was quantified with the median rate ratio, which can be interpreted as the likelihood that 2 random practices would differ in treating "identical" patients with warfarin. Overall rate of warfarin treatment was only 55.1% (5,018 of 9,913). Untreated patients and treated patients had mean congestive heart failure, hypertension, age, diabetes, stroke scores of 2.5 (p = 0.38) and similar rates of heart failure, hypertension, diabetes mellitus, and previous stroke, suggesting an almost "random" pattern of treatment. At the practice level, however, there was substantial variation in treatment ranging from 25% to 80% (interquartile range for practices 50 to 65), with a median rate ratio of 1.31 (1.22 to 1.55, p <0.001). In conclusion, within the Practice Innovation and Clinical Excellence registry, we found that warfarin treatment in AF was suboptimal, with large variations in treatment observed across practices. Our findings suggest important opportunities for practice-level improvement in stroke prevention for outpatients with AF and define a benchmark treatment rate before the introduction of newer anticoagulant agents.     

One-year clinical outcome of patients with nonvalvular atrial fibrillation: Insights from KERALA-AF registry

BackgroundWe report patient characteristics, treatment pattern and one-year clinical outcome of nonvalvular atrial fibrillation (NVAF) from Kerala, India. This cohort forms part of Kerala Atrial Fibrillation (KERALA-AF) registry which is an ongoing large prospective study.MethodsKERALA-AF registry collected data of adults with previously or newly diagnosed atrial fibrillation (AF) during April 2016 to April 2017. A total of 3421 patients were recruited from 53 hospitals across Kerala state. We analysed one-year follow-up outcome of 2507 patients with NVAF.ResultsMean age at recruitment was 67.2 years (range 18–98) and 54.8% were males. Main co-morbidities were hypertension (61.2%), hyperlipidaemia (46.2%) and diabetes mellitus (37.2%). Major co-existing diseases were chronic kidney disease (42.1%), coronary artery disease (41.6%), and chronic heart failure (26.4%). Mean CHA₂DS₂-VASc score was 3.18 (SD ± 1.7) and HAS-BLED score, 1.84 (SD ± 1.3). At baseline, use of oral anticoagulants (OAC) was 38.6% and antiplatelets 32.7%. On one-month follow-up use of OAC increased to 65.8% and antiplatelets to 48.3%. One-year all-cause mortality was 16.48 and hospitalization 20.65 per 100 person years. The main causes of death were cardiovascular (75.0%), stroke (13.1%) and others (11.9%). The major causes of hospitalizations were acute coronary syndrome (35.0%), followed by arrhythmia (29.5%) and heart failure (8.4%).ConclusionsDespite high risk profile of patients in this registry, use of OAC was suboptimal, whereas antiplatelets were used in nearly half of patients. A relatively high rate of annual mortality and hospitalization was observed in patients with NVAF in Kerala AF Registry.     

Alternatives to chronic warfarin therapy for the prevention of stroke in patients with atrial fibrillation

Atrial fibrillation (AF) is associated with a fivefold increased risk for stroke due to thromboembolic events. Warfarin remains the standard medical therapy for decades in these patients but is difficult to use safely and conveniently. Chronic warfarin therapy is contraindicated in 14% to 44% of patients with AF who are at risk for stroke. In clinical practice, warfarin is prescribed to only 15% to 60% of patients with AF who are at high risk for thromboembolic events and have no clear contraindication to their use. Alternatives to warfarin include (i) antiplatelet therapy; (ii) new oral anticoagulants; and (iii) exclusion of the left atrial appendage (LAA) as a major embolic source. Dual antiplatelet therapy with aspirin and clopidogrel was superior to aspirin alone in reducing the risk of stroke in patients unsuitable to warfarin. Furthermore, a number of newer oral anticoagulants are currently under investigation for stroke prevention in AF. Oral direct thrombin or factor Xa inhibitors are in the most advanced stages of development. Given that about 90% of the source of thromboembolism occurs in the LAA in patients with non-valvular AF, occlusion of flow into the LAA may prevent thrombus formation in the appendage and hence reduction of stroke. Recently, several devices have been employed percutaneously with encouraging results in selected patients. Current review summarizes the latest clinical trial data pertinent to dual-antiplatelet therapy, several newer antithrombotic agents and LAA occlusion.