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- W2019293007 abstract "Stroke is the fourth leading cause of death in the United States. Atrial fibrillation (AF) increases the risk of ischemic stroke 5-fold.1 Strokes associated with AF are more severe when compared with non-AF strokes with a 30-day mortality of 25%.2 As such, a crucial component of AF management is stroke prevention. Oral anticoagulation therapy with warfarin effectively reduces the rate of stroke by 64% when compared with placebo and by 37% when compared with antiplatelet agents alone.3 Non–vitamin K antagonist oral anticoagulants have been shown to dramatically reduce the risk of intracranial hemorrhage when compared with warfarin and are guideline-sanctioned alternatives.4–6 However, similar or higher rates of gastrointestinal hemorrhage and medication adherence constitute longer term challenges with anticoagulant drugs. An alternative method of stroke prevention is needed for high-risk patients with refractory bleeding, untenable bleeding risk,7 or persistent medication nonadherence despite multiple interventions.Article see p 42The rationale behind left atrial appendage (LAA) closure stems from the observation that among individuals in whom left atrial thrombus can be visualized, 90% are located in the LAA.8 The Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation (PROTECT AF) trial demonstrated the device to be noninferior to warfarin for the primary efficacy end point comprised ischemic and hemorrhagic stroke, cardiovascular or unexplained death, or systemic embolism (3.0 for the device versus 4.9 for warfarin per 100 patient-years, rate ratio, 0.62; 95% confidence interval, 0.35–1.25).9,10 However, the trial had several limitations, …" @default.
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- W2019293007 date "2015-02-01" @default.
- W2019293007 modified "2023-10-18" @default.
- W2019293007 title "Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation" @default.
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- W2019293007 doi "https://doi.org/10.1161/circep.115.002634" @default.
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