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Left Atrial Appendage Closure More Effective than Blood Thinners to Prevent Deadly Stroke Complications in Afib Patients
Study could change standard of care for this patient population
Study could change standard of care for this patient population
Atrial fibrillation (Afib) patients who have strokes linked to a blood clot in the heart have fewer disabling complications and lower risk of death if they have a left atrial appendage closure procedure (LAAC) compared to being treated with blood thinners. Both LAAC and blood thinners are the current standards of treatment for preventing strokes in this patient population; however, strokes can (infrequently) still occur and be deadly. This study shows that LAAC may be a more favorable option than blood thinners to prevent serious stroke complications among high-risk patients.
Why this study is unique: This is the largest study of its kind comparing outcomes of strokes from a blood clot from the heart in atrial fibrillation patients treated with LAAC versus blood thinners.
Why the study is important: Afib is a heart condition that causes an irregular heartbeat, affecting roughly 6-million Americans and raises the risk of a serious stroke. Strokes due to Afib are linked to a blood clot in the heart and tend to be more serious with increased brain damage and more severe long-term effects. Cardiologists have two treatment options to prevent strokes in this patient population – blood thinners, or LAAC which is a catheter procedure to close off this section of the heart called left atrial appendage where clots are more prone to forming in Afib. Despite these treatment options, a small proportion of patients have strokes. This study assessed the severity of these strokes in patients who had a stroke while on blood thinners or had a left atrial appendage closure strategy. Results show that Afib patients who had a stroke linked to a blood clot in the heart after LAAC had better neurological outcomes when compared to patients who had a stroke while on blood thinners and had no LAAC.
How the research was conducted: Researchers did a retrospective analysis using registries from eight heart centers across the United States and Europe. They compared 322 patients who had stroke from a blood clot in the heart while receiving blood thinners with 125 patients who had a stroke after having LAAC. Researchers used a Rankin Scale to assess severity of patient strokes. Researchers analyzed stroke severity right before patients were discharged from the hospital following a stroke, and then again at three months after the stroke.
Results: Patients who had a stroke while taking blood thinners had a 70.3 percent incidence of having disabling symptoms or dying at discharge, compared to 38.3 percent incidence among patients who had LAAC. The incidence was also lower for the LAAC group at three months after discharge at 33.3 percent, compared to 56.2 percent for the blood thinner patients. Analysis showed that patients who underwent LAAC had a 78 percent lower risk of having complications from a disabling stroke when compared to those on blood thinners at the time of hospital discharge, and 72 percent lower risk three months after hospital discharge.
What this study means for cardiologists: Patients treated with LAAC who had a stroke due to a blood clot from the heart had better outcomes than those receiving blood thinners. To validate these findings, larger, prospective studies should be conducted – some of these studies are currently underway and these can provide a better understanding of why these different treatments options may contribute to different results for stroke patients.
What this study means for patients? This provides reassurance new insight on the safety and effectiveness of LAAC in atrial fibrillation patients who are at high-risk of bleeding with blood thinners.
Quotes:
“Despite a higher baseline risk profile, left atrial appendage closure related ischemic strokes were less severe and less fatal than with direct-oral anticoagulants. The mechanism(s) of these stroke severity differences is unknown. This analysis partially explains the emerging data identifying a mortality benefit of LAAC over direct-oral anticoagulant therapy. These are important data to reflect upon by patients and clinicians alike when considering options for AF stroke prophylaxis,” says Mohit Turagam, MD, Associate Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai.
“Both of these strategies, LAAC and blood thinners, are overall effective in preventing stroke in patients with AFib, but strokes can infrequently still occur with either prevention strategy. These data indicate that these breakthrough strokes are considerably worse when they occur while taking blood thinners – the strokes are more severe and more often fatal – than after LAAC,” says Vivek Reddy, MD, Professor of Medicine (Cardiology) at Icahn School of Medicine at Mount Sinai.
Reference
Severity of Ischemic Stroke After Left Atrial Appendage Closure vs Nonwarfarin Oral Anticoagulants
Mohit Turagam, MD, Associate Professor of Medicine (Cardiology) and at the Icahn School of Medicine at Mount Sinai
Vivek Reddy, MD, The Leona M. and Harry B. Helmsley Charitable Trust Professor of Medicine in Cardiac Electrophysiology at Icahn Mount Sinai Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai
Journal of the American College of Cardiology: Clinical Electrophysiology
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