Non-vitamin K antagonist oral anticoagulation versus left atrial appendage occlusion for primary and secondary stroke prevention after cardioembolic stroke |
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Authors: | Luís Paiva José Coelho Sérgio Barra Marco Costa João Sargento-Freitas Luís Cunha Lino Gonçalves |
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Institution: | 1. Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal;2. Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal;3. Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal;4. Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK;5. Hospital da Arrábida, Vila Nova de Gaia, Portugal |
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Abstract: | IntroductionThis study aimed to evaluate the performance of non-vitamin K antagonist oral anticoagulation (NOAC) in patients with previous stroke and non-valvular atrial fibrillation (AF) compared with left atrial appendage occlusion (LAAO) in primary and secondary stroke prevention settings.MethodsThis was a prospective, single-center, non-randomized cohort study of 302 consecutive patients with non-valvular AF and at high risk for stroke. Two treatment strategies were compared: LAAO (n=91) and long-term treatment with NOAC (n=149). The primary outcome was the composite endpoint of death, stroke and major bleeding. Propensity score and cause-of-death analyses were performed to compare outcomes.ResultsIn a mean follow-up of 13 months, there were 30 deaths (LAAO 8.8% vs. NOAC 14.8%), five strokes (LAAO 1.1% vs. NOAC 2.7%) and six major bleeds (LAAO 1.1% vs. NOAC 3.4%). There was a non-significant trend for a lower incidence of the primary endpoint in the LAAO group (11.0% vs. 20.9%; HR 0.42, 95% CI 0.17-1.05, p=0.064). Considering only secondary prevention LAAO patients (34.1% of the LAAO group), there was also a non-significant lower incidence of the primary endpoint (LAAO 6.5% vs. 20.9%; HR 0.30, 95% CI 0.07-1.39, p=0.12). While about a fifth of LAAO patients stopped antiplatelet treatment six months after device implantation due to recurrent minor bleeding, no adverse cardiovascular event or major bleeding occurred in this subset of patients.ConclusionIn this registry-based study, LAAO was a reasonable alternative to NOAC for the prevention of a composite endpoint of all-cause mortality, stroke and major bleeding in patients at high risk for stroke. |
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Keywords: | Left atrial appendage Occlusion Antiplatelet Oral anticoagulation Apêndice auricular esquerdo Oclusão Antiplaquetários Anticoagulação oral |
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