background The occurrence of acute ischaemic stroke(AIS)while using oral anticoagulants(OAC)is an increasingly recognised problem among nonvalvular atrial fibrillation(NVAF)patients.We aimed to elucidate the potential...background The occurrence of acute ischaemic stroke(AIS)while using oral anticoagulants(OAC)is an increasingly recognised problem among nonvalvular atrial fibrillation(NVAF)patients.We aimed to elucidate the potential role of left atrial appendage closure(LAAC)for stroke prevention in patients with AIS despite OAC use(AIS-despite OAC).Methods We retrospectively collected baseline and follow-up data from consecutive NVAF patients who had AIS-despite OAC and subsequently underwent endovascular LAAC,between January 2015 and October 2021.The primary outcome measure was the occurrence of AIS after LAAC,and the safety outcome was symptomatic intracerebral haemorrhage(ICH).results 29 patients had LAAC specifically because of AIS-despite OAC.The mean age at the time of the procedure was 73.4±8.7,13 were female(44.82%).The mean CHA2DS2-VASc score was 5.96±1.32,with an expected AIS risk of 8.44 per 100 patient-years.14 patients(48%)had two or more past AIS-despite OAC.After LAAC,27 patients(93.10%)were discharged on OAC which was discontinued in 17(58.62%)after transoesophageal echocardiogram at 6 weeks.Over a mean of 1.75±1.0 years follow-up after LAAC,one patient had an AIS(incidence rate(IR)1.97 per 100 patient-years).One patient with severe cerebral microangiopathy had a small ICH while on direct OAC and antiplatelet 647 days after LAAC.Conclusions LAAC in AIS-despite OAC patients demonstrated a low annual AIS recurrence rate in our cohort(1.97%)compared with the expected IR based on their CHA2DS2-VASc scores(8.44%)and to recent large series of AIS-despite OAC patients treated with OAC/aspirin only(5.3%-8.9%).These hypothesis-generating findings support randomised trials of LAAC in AIS-despite OAC patients.展开更多
Background and objectives Although left atrial appendage closure(LAAC)is performed in patients with non-valvular atrial fibrillation(NVAF)at increased risk of intracranial haemorrhage(ICH),outcome data are scarce.We a...Background and objectives Although left atrial appendage closure(LAAC)is performed in patients with non-valvular atrial fibrillation(NVAF)at increased risk of intracranial haemorrhage(ICH),outcome data are scarce.We assessed the detailed neurological indications for LAAC and outcomes after LAAC in high ICH risk patients.Methods Study population included consecutive patients with NVAF who underwent LAAC in a single hospital network between January 2015 and October 2021 because of prior ICH or the presence of high ICH risk imaging markers on brain MRI(cerebral microbleeds(CMBs)).Primary safety and efficacy outcome measures were the occurrence of ICH and thromboembolic events,respectively,after LAAC.Results Among 146 patients with NVAF who underwent LAAC for high ICH risk,122 had a history of ICH,while 24 presented with high ICH risk imaging markers only.Mean age was 75.7±7.61,42(28.8%)were women.Mean CHA2DS2-VASc score was 5.23±1.52.Of 122 patients with ICH history,58(47.5%)had intraparenchymal haemorrhage(IPH),40(32.8%)had traumatic ICH(T-ICH)and 18(14.7%)had non-traumatic subdural haemorrhage.Of 85 patients with brain MRIs including necessary sequences,43(50.6%)were related to cerebral amyloid angiopathy and 37(43.5%)to hypertensive microangiopathy.While 70%of patients were discharged on oral anticoagulants(OAC),92%were not taking OAC at 1 year.Over 2.12 years mean follow-up,one patient had recurrent non-traumatic IPH(incidence rate(IR)0.32 per 100 patient-years),five had T-ICH(IR 1.61 per 100 patient-years)and six had an ischaemic stroke(IR 1.94 per 100 patient-years).Conclusions Among patients with NVAF at high ICH risk,LAAC demonstrated a low risk of recurrent ICH or ischaemic stroke compared with previously published data.LAAC in high ICH risk populations should be considered in clinical practice per FDA approval and recent guidelines.展开更多
文摘background The occurrence of acute ischaemic stroke(AIS)while using oral anticoagulants(OAC)is an increasingly recognised problem among nonvalvular atrial fibrillation(NVAF)patients.We aimed to elucidate the potential role of left atrial appendage closure(LAAC)for stroke prevention in patients with AIS despite OAC use(AIS-despite OAC).Methods We retrospectively collected baseline and follow-up data from consecutive NVAF patients who had AIS-despite OAC and subsequently underwent endovascular LAAC,between January 2015 and October 2021.The primary outcome measure was the occurrence of AIS after LAAC,and the safety outcome was symptomatic intracerebral haemorrhage(ICH).results 29 patients had LAAC specifically because of AIS-despite OAC.The mean age at the time of the procedure was 73.4±8.7,13 were female(44.82%).The mean CHA2DS2-VASc score was 5.96±1.32,with an expected AIS risk of 8.44 per 100 patient-years.14 patients(48%)had two or more past AIS-despite OAC.After LAAC,27 patients(93.10%)were discharged on OAC which was discontinued in 17(58.62%)after transoesophageal echocardiogram at 6 weeks.Over a mean of 1.75±1.0 years follow-up after LAAC,one patient had an AIS(incidence rate(IR)1.97 per 100 patient-years).One patient with severe cerebral microangiopathy had a small ICH while on direct OAC and antiplatelet 647 days after LAAC.Conclusions LAAC in AIS-despite OAC patients demonstrated a low annual AIS recurrence rate in our cohort(1.97%)compared with the expected IR based on their CHA2DS2-VASc scores(8.44%)and to recent large series of AIS-despite OAC patients treated with OAC/aspirin only(5.3%-8.9%).These hypothesis-generating findings support randomised trials of LAAC in AIS-despite OAC patients.
文摘Background and objectives Although left atrial appendage closure(LAAC)is performed in patients with non-valvular atrial fibrillation(NVAF)at increased risk of intracranial haemorrhage(ICH),outcome data are scarce.We assessed the detailed neurological indications for LAAC and outcomes after LAAC in high ICH risk patients.Methods Study population included consecutive patients with NVAF who underwent LAAC in a single hospital network between January 2015 and October 2021 because of prior ICH or the presence of high ICH risk imaging markers on brain MRI(cerebral microbleeds(CMBs)).Primary safety and efficacy outcome measures were the occurrence of ICH and thromboembolic events,respectively,after LAAC.Results Among 146 patients with NVAF who underwent LAAC for high ICH risk,122 had a history of ICH,while 24 presented with high ICH risk imaging markers only.Mean age was 75.7±7.61,42(28.8%)were women.Mean CHA2DS2-VASc score was 5.23±1.52.Of 122 patients with ICH history,58(47.5%)had intraparenchymal haemorrhage(IPH),40(32.8%)had traumatic ICH(T-ICH)and 18(14.7%)had non-traumatic subdural haemorrhage.Of 85 patients with brain MRIs including necessary sequences,43(50.6%)were related to cerebral amyloid angiopathy and 37(43.5%)to hypertensive microangiopathy.While 70%of patients were discharged on oral anticoagulants(OAC),92%were not taking OAC at 1 year.Over 2.12 years mean follow-up,one patient had recurrent non-traumatic IPH(incidence rate(IR)0.32 per 100 patient-years),five had T-ICH(IR 1.61 per 100 patient-years)and six had an ischaemic stroke(IR 1.94 per 100 patient-years).Conclusions Among patients with NVAF at high ICH risk,LAAC demonstrated a low risk of recurrent ICH or ischaemic stroke compared with previously published data.LAAC in high ICH risk populations should be considered in clinical practice per FDA approval and recent guidelines.
