Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication
BACKGROUND Left atrial appendage occlusion (LAAO) provides mechanical cardioembolic protection for atrial fibrillation (AF) patients who cannot use oral anticoagulation therapy (OAT). Patients with a thrombotic event despite OAT are at high risk for recurrence and may also bene fit from LAAO. OBJECT...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repositorio: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p19233 |
| Acceso en línea: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=19233 https://ddd.uab.cat/record/324020 |
| Access Level: | acceso abierto |
| Palabra clave: | KEY WORDS anticoagulation failure atrial fi brillation ischemic stroke left atrial appendage occlusion |
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Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation ContraindicationAarnink, EWMaarse, MFierro, NMazzone, PBeneduce, ATondo, CGasperetti, APracon, RDemkow, MZielinski, Kde Backer, OKorsholm, KNielsen-Kudsk, JEEstévez-Loureiro, RCaneiro-Queija, BBenito-González, Tde Prado, APNombela-Franco, LSalinas, PHolmes, DAlmakadma, AHBerti, SRomeo, MRMillan, XArzamendi, DAlla, VMAgarwal, HEitel, IPaitazoglou, CFreixa, XCepas-Guillén, PChothia, RBadejoko, SOSpoon, DBMaddux, JTEl-Chami, MRam, PBranca, LAdamo, MSuradi, HSPeper, Jvan Dijk, VFRensing, BJWMSwaans, MJVireca, EBergmann, MWBoersma, LVAKEY WORDS anticoagulation failureatrial fi brillationischemic strokeleft atrial appendage occlusionBACKGROUND Left atrial appendage occlusion (LAAO) provides mechanical cardioembolic protection for atrial fibrillation (AF) patients who cannot use oral anticoagulation therapy (OAT). Patients with a thrombotic event despite OAT are at high risk for recurrence and may also bene fit from LAAO. OBJECTIVES This study sought to investigate the ef ficacy of LAAO in AF patients with a thrombotic event on OAT compared to: 1) LAAO in AF patients with a contraindication for OAT; and 2) historical data. METHODS The international LAAO after stroke despite oral anticoagulation (STR-OAC LAAO) collaboration included patients who underwent LAAO because of thrombotic events on OAT. This cohort underwent propensity score matching and was compared to the EWOLUTION (Evaluating Real-Life Clinical Outcomes in Atrial Fibrillation Patients Receiving WATCHMAN Left Atrial Appendage Closure Technology) registry, which represents patients who underwent LAAO because of OAT contraindications. The primary outcome was ischemic stroke. Event rates were compared between cohorts and with historical data without OAT, yielding relative risk reductions based on risk scores. RESULTS Analysis of 438 matched pairs revealed no signi ficant difference in the ischemic stroke rate between the STR-OAC LAAO and EWOLUTION cohorts (2.5% vs 1.9%; HR: 1.37; 95% CI: 0.72-2.61). STR-OAC LAAO patients exhibited a higher thromboembolic risk (HR: 1.71; 95% CI: 1.04-2.83) but lower bleeding risk (HR: 0.39; 95% CI: 0.18-0.88) compared to EWOLUTION patients. The mortality rate was slightly higher in EWOLUTION (4.3% vs 6.9%; log -rank P 1 / 4 0.028). Relative risk reductions for ischemic stroke were 70% and 78% in STR-OAC LAAO and EWOLUTION, respectively, compared to historical data without OAT. CONCLUSIONS LAAO in patients with a thrombotic event on OAT demonstrated comparable stroke rates to the contraindicated population in EWOLUTION. The thromboembolic event rate was higher and the bleeding rate lower, reftecting the intrinsically different risk pro file of both populations. Until randomized trials are available, LAAO may considered in patients with an ischemic event on OAT. (J Am Coll Cardiol Intv 2024;17:1311 -1321) (c) 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).ELSEVIER SCIENCE INC2024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=19233https://ddd.uab.cat/record/324020JACC-Cardiovascular InterventionsISSN: 19368798ISSNe: 18767605reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p192332026-06-14T12:41:47Z |
| dc.title.none.fl_str_mv |
Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication |
| title |
Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication |
| spellingShingle |
Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication Aarnink, EW KEY WORDS anticoagulation failure atrial fi brillation ischemic stroke left atrial appendage occlusion |
| title_short |
Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication |
| title_full |
Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication |
| title_fullStr |
Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication |
| title_full_unstemmed |
Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication |
| title_sort |
Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication |
| dc.creator.none.fl_str_mv |
Aarnink, EW Maarse, M Fierro, N Mazzone, P Beneduce, A Tondo, C Gasperetti, A Pracon, R Demkow, M Zielinski, K de Backer, O Korsholm, K Nielsen-Kudsk, JE Estévez-Loureiro, R Caneiro-Queija, B Benito-González, T de Prado, AP Nombela-Franco, L Salinas, P Holmes, D Almakadma, AH Berti, S Romeo, MR Millan, X Arzamendi, D Alla, VM Agarwal, H Eitel, I Paitazoglou, C Freixa, X Cepas-Guillén, P Chothia, R Badejoko, SO Spoon, DB Maddux, JT El-Chami, M Ram, P Branca, L Adamo, M Suradi, HS Peper, J van Dijk, VF Rensing, BJWM Swaans, MJ Vireca, E Bergmann, MW Boersma, LVA |
| author |
Aarnink, EW |
| author_facet |
Aarnink, EW Maarse, M Fierro, N Mazzone, P Beneduce, A Tondo, C Gasperetti, A Pracon, R Demkow, M Zielinski, K de Backer, O Korsholm, K Nielsen-Kudsk, JE Estévez-Loureiro, R Caneiro-Queija, B Benito-González, T de Prado, AP Nombela-Franco, L Salinas, P Holmes, D Almakadma, AH Berti, S Romeo, MR Millan, X Arzamendi, D Alla, VM Agarwal, H Eitel, I Paitazoglou, C Freixa, X Cepas-Guillén, P Chothia, R Badejoko, SO Spoon, DB Maddux, JT El-Chami, M Ram, P Branca, L Adamo, M Suradi, HS Peper, J van Dijk, VF Rensing, BJWM Swaans, MJ Vireca, E Bergmann, MW Boersma, LVA |
| author_role |
author |
| author2 |
Maarse, M Fierro, N Mazzone, P Beneduce, A Tondo, C Gasperetti, A Pracon, R Demkow, M Zielinski, K de Backer, O Korsholm, K Nielsen-Kudsk, JE Estévez-Loureiro, R Caneiro-Queija, B Benito-González, T de Prado, AP Nombela-Franco, L Salinas, P Holmes, D Almakadma, AH Berti, S Romeo, MR Millan, X Arzamendi, D Alla, VM Agarwal, H Eitel, I Paitazoglou, C Freixa, X Cepas-Guillén, P Chothia, R Badejoko, SO Spoon, DB Maddux, JT El-Chami, M Ram, P Branca, L Adamo, M Suradi, HS Peper, J van Dijk, VF Rensing, BJWM Swaans, MJ Vireca, E Bergmann, MW Boersma, LVA |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
KEY WORDS anticoagulation failure atrial fi brillation ischemic stroke left atrial appendage occlusion |
| topic |
KEY WORDS anticoagulation failure atrial fi brillation ischemic stroke left atrial appendage occlusion |
| description |
BACKGROUND Left atrial appendage occlusion (LAAO) provides mechanical cardioembolic protection for atrial fibrillation (AF) patients who cannot use oral anticoagulation therapy (OAT). Patients with a thrombotic event despite OAT are at high risk for recurrence and may also bene fit from LAAO. OBJECTIVES This study sought to investigate the ef ficacy of LAAO in AF patients with a thrombotic event on OAT compared to: 1) LAAO in AF patients with a contraindication for OAT; and 2) historical data. METHODS The international LAAO after stroke despite oral anticoagulation (STR-OAC LAAO) collaboration included patients who underwent LAAO because of thrombotic events on OAT. This cohort underwent propensity score matching and was compared to the EWOLUTION (Evaluating Real-Life Clinical Outcomes in Atrial Fibrillation Patients Receiving WATCHMAN Left Atrial Appendage Closure Technology) registry, which represents patients who underwent LAAO because of OAT contraindications. The primary outcome was ischemic stroke. Event rates were compared between cohorts and with historical data without OAT, yielding relative risk reductions based on risk scores. RESULTS Analysis of 438 matched pairs revealed no signi ficant difference in the ischemic stroke rate between the STR-OAC LAAO and EWOLUTION cohorts (2.5% vs 1.9%; HR: 1.37; 95% CI: 0.72-2.61). STR-OAC LAAO patients exhibited a higher thromboembolic risk (HR: 1.71; 95% CI: 1.04-2.83) but lower bleeding risk (HR: 0.39; 95% CI: 0.18-0.88) compared to EWOLUTION patients. The mortality rate was slightly higher in EWOLUTION (4.3% vs 6.9%; log -rank P 1 / 4 0.028). Relative risk reductions for ischemic stroke were 70% and 78% in STR-OAC LAAO and EWOLUTION, respectively, compared to historical data without OAT. CONCLUSIONS LAAO in patients with a thrombotic event on OAT demonstrated comparable stroke rates to the contraindicated population in EWOLUTION. The thromboembolic event rate was higher and the bleeding rate lower, reftecting the intrinsically different risk pro file of both populations. Until randomized trials are available, LAAO may considered in patients with an ischemic event on OAT. (J Am Coll Cardiol Intv 2024;17:1311 -1321) (c) 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
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2024 |
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2024 |
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info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
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https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=19233 https://ddd.uab.cat/record/324020 |
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https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=19233 https://ddd.uab.cat/record/324020 |
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Inglés |
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Inglés |
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info:eu-repo/semantics/openAccess |
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openAccess |
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ELSEVIER SCIENCE INC |
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ELSEVIER SCIENCE INC |
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JACC-Cardiovascular Interventions ISSN: 19368798 ISSNe: 18767605 reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
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Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
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r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
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r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
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