Universität zu Köln

Cruz-Gonzalez, Ignacio, Gonzalez-Ferreiro, Rocio, Freixa, Xavier, Gafoor, Sameer, Shakir, Samera, Omran, Heyder, Berti, Sergio, Santoro, Gennaro, Kefer, Joelle, Landmesser, Ulf, Nielsen-Kudsk, Jens Erik, Kanagaratnam, Prapa, Nietlispach, Fabian, Gloekler, Steffen, Aminian, Adel, Danna, Paolo, Rezzaghi, Marco, Stock, Friederike, Stolcova, Miroslava, Paiva, Luis, Costa, Marco, Millan, Xavier, Ibrahim, Reda, Tichelbacker, Tobias, Schillinger, Wolfgang, Park, Jai-Wun, Sievert, Horst, Meier, Bernhard and Tzikas, Apostolos (2020). Left atrial appendage occlusion for stroke despite oral anticoagulation (resistant stroke). Results from the Amplatzer Cardiac Plug registry. Rev. Esp. Cardiol., 73 (1). S. 28 - 35. BARCELONA: EDICIONES DOYMA S A. ISSN 1579-2242

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Abstract

Introduction and objectives: Despite the efficacy of oral anticoagulant (OAC) therapy, some patients continue to have a high residual risk and develop a stroke on OAC therapy (resistant stroke [RS]), and there is a lack of evidence on the management of these patients. The aim of this study was to analyze the safety and efficacy of left atrial appendage occlusion (LAAO) as secondary prevention in patients with nonvalvular atrial fibrillation who have experienced a stroke/transient ischemic attack despite OAC treatment. Methods: We analyzed data from the Amplatzer Cardiac Plug multicenter registry on 1047 consecutive patients with nonvalvular atrial fibrillation undergoing LAAO. Patientes with previous stroke on OAC therapy as indication for LAAO were identified and compared with patients with other indications. Results: A total of 115 patients (11%) with RS were identified. The CHA(2)DS(2)-VASc and the HAS-BLED score were significantly higher in the RS group (respectively 5.5 +/- 1.5 vs 4.3 +/- 1.6; P < .001; 3.9 +/- 1.3 vs 3.1 +/- 1.2; P < .001). No significant differences were observed in periprocedural major safety events (7.8 vs 4.5%; P = .1). With a mean clinical follow-up of 16.2 +/- 12.2 months, the observed annual stroke/transient ischemic attack rate for the RS group was 2.6% (65% risk reduction) and the observed annual major bleeding rate was 0% (100% risk reduction). Conclusions: Patients with RS undergoing LAAO showed similar safety outcomes to patients without RS, with a significant reduction in stroke/transient ischemic attack and major bleeding events during follow-up. Adequately powered controlled trials are needed to further investigate the use of LAAO in RS patients. (C) 2019 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Cruz-Gonzalez, Ignacio UNSPECIFIED UNSPECIFIED UNSPECIFIED Gonzalez-Ferreiro, Rocio UNSPECIFIED UNSPECIFIED UNSPECIFIED Freixa, Xavier UNSPECIFIED UNSPECIFIED UNSPECIFIED Gafoor, Sameer UNSPECIFIED UNSPECIFIED UNSPECIFIED Shakir, Samera UNSPECIFIED UNSPECIFIED UNSPECIFIED Omran, Heyder UNSPECIFIED UNSPECIFIED UNSPECIFIED Berti, Sergio UNSPECIFIED UNSPECIFIED UNSPECIFIED Santoro, Gennaro UNSPECIFIED UNSPECIFIED UNSPECIFIED Kefer, Joelle UNSPECIFIED UNSPECIFIED UNSPECIFIED Landmesser, Ulf UNSPECIFIED UNSPECIFIED UNSPECIFIED Nielsen-Kudsk, Jens Erik UNSPECIFIED UNSPECIFIED UNSPECIFIED Kanagaratnam, Prapa UNSPECIFIED UNSPECIFIED UNSPECIFIED Nietlispach, Fabian UNSPECIFIED UNSPECIFIED UNSPECIFIED Gloekler, Steffen UNSPECIFIED UNSPECIFIED UNSPECIFIED Aminian, Adel UNSPECIFIED UNSPECIFIED UNSPECIFIED Danna, Paolo UNSPECIFIED UNSPECIFIED UNSPECIFIED Rezzaghi, Marco UNSPECIFIED UNSPECIFIED UNSPECIFIED Stock, Friederike UNSPECIFIED UNSPECIFIED UNSPECIFIED Stolcova, Miroslava UNSPECIFIED UNSPECIFIED UNSPECIFIED Paiva, Luis UNSPECIFIED UNSPECIFIED UNSPECIFIED Costa, Marco UNSPECIFIED UNSPECIFIED UNSPECIFIED Millan, Xavier UNSPECIFIED UNSPECIFIED UNSPECIFIED Ibrahim, Reda UNSPECIFIED UNSPECIFIED UNSPECIFIED Tichelbacker, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED Schillinger, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Park, Jai-Wun UNSPECIFIED UNSPECIFIED UNSPECIFIED Sievert, Horst UNSPECIFIED UNSPECIFIED UNSPECIFIED Meier, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Tzikas, Apostolos UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-352511
DOI:	10.1016/j.recesp.2019.02.018
Journal or Publication Title:	Rev. Esp. Cardiol.
Volume:	73
Number:	1
Page Range:	S. 28 - 35
Date:	2020
Publisher:	EDICIONES DOYMA S A
Place of Publication:	BARCELONA
ISSN:	1579-2242
Language:	Spanish
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TRANSIENT ISCHEMIC ATTACK; RISK STRATIFICATION; SUBGROUP ANALYSIS; FIBRILLATION; WARFARIN; PREVENTION; THERAPY; CLOSURE; METAANALYSIS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/35251