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Title: Non-vitamin K antagonist oral anticoagulation versus left atrial appendage occlusion for primary and secondary stroke prevention after cardioembolic stroke
Authors: Paiva, Luís 
Coelho, José 
Barra, Sérgio
Costa, Marco
Sargento-Freitas, João 
Cunha, Luís 
Gonçalves, Lino 
Keywords: Antiplatelet; Left atrial appendage; Occlusion; Oral anticoagulation
Issue Date: 2021
Serial title, monograph or event: Revista Portuguesa de Cardiologia
Volume: 40
Issue: 5
Abstract: Introduction: This 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. Methods: This 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-ofdeath analyses were performed to compare outcomes. Results: In 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.
ISSN: 08702551
DOI: 10.1016/j.repc.2020.07.021
Rights: openAccess
Appears in Collections:FMUC Medicina - Artigos em Revistas Internacionais

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