Conference Coverage

LAA occlusion boosts anticoagulants’ protection



– When patients with atrial fibrillation have a history of cardioembolic events despite optimal anticoagulant therapy, treatment with left atrial appendage occlusion can substantially improve protection against future events, according to a multicenter review of 22 patients.

During the 2 years prior to undergoing left atrial appendage (LAA) occlusion, the 22 atrial fibrillation (AF) patients studied had a total of 44 cardioembolic events despite receiving “optimal” treatment with an oral anticoagulant, including nine patients with one event, six patients with two events, five patients with three events, and two patients with four events each, Xavier Freixa, MD, said at the annual International AF Symposium. In contrast, during a median follow-up of 1.8 years after their procedure additional events occurred in just two patients – one with a stroke, the other with a transient ischemic attack, while the remaining 20 patients remained free of any additional events.

Dr. Xavier Freixa, proctor for Abbott Medical Mitchel L. Zoler/Frontline Medical News

Dr. Xavier Freixa

Based on this experience, Dr. Freixa and his associates have changed their practice and now are much more apt to proceed with LAA occlusion, generally recommending it when an AF patient experiences a single cardioembolic event despite treatment with an oral anticoagulant, he said.

The analysis also revealed that the two patients who had cardioembolic events following their LAA occlusion had been withdrawn from oral anticoagulant treatment by their physicians, who had done this with a “false feeling of comfort,” said Dr. Freixa, an interventional cardiologist at the University Hospital Clinic of Barcelona. These two patients were among three patients maintained on dual-antiplatelet therapy rather than on an oral anticoagulant following LAA occlusion. The remaining 19 patients had remained on either warfarin, a novel oral anticoagulant, or both.

The study included patients from eight Spanish centers who underwent LAA occlusion during June 2009–June 2017, and included 14 with nonvalvular AF and 8 with valvular AF who had all undergone prior valve surgery. None of the 22 patients had a contraindication for treatment with an oral anticoagulant. They averaged about 69 years of age. Prior to their procedure, 18 had at least one stroke or transient ischemic attack, and the remaining 4 patients had at least one systemic embolism. Nineteen patients underwent occlusion with either an Amplatzer Cardiac Plug or Amplatzer Amulet device, two received a Watchman device, and one patient received a LAmbre device. All of the closure procedures were successful, with no complications.

“I think any device will do well for these patients as long as we occlude the LAA,” Dr. Freixa said.

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SOURCE: Freixa X et al. AF Symposium 2018 Abstract 1821.

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