Percutaneous left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation

IF 0.6 Q4 CLINICAL NEUROLOGY

Future Neurology Pub Date : 2020-08-01 DOI:10.2217/fnl-2020-0001

H. Diener, U. Landmesser

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Abstract

Patients with atrial fibrillation (AF) have a fivefold higher risk of stroke than persons in sinus rhythm. Effective stroke prevention is achieved with oral anticoagulants such as vitamin K antagonists or nonvitamin K oral anticoagulants. An alternative for stroke prevention in patients with AF is the closure of the left atrial appendage (LAA) with a percutaneously applied closure system. The two large randomized studies PROTECT-AF and PREVAIL failed to show superiority of LAA closure over anticoagulation in patients with AF. Meta-analyses of studies and registries, however, suggest that LAA closure has particular advantages with regard to the reduction of severe bleeding complications. Currently, several prospective randomized studies are being conducted in different patient populations to evaluate the benefit of LAA closure in comparison to standard of care. Currently, LAA closure is recommended in patients after intracranial hemorrhage, with advanced renal failure, after severe gastrointestinal bleeding, in patients with a high risk of recurrent ischemic stroke and elderly patients with high risk of bleeding and falling.

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经皮左心耳封堵术预防心房颤动患者中风

心房颤动（AF）患者发生中风的风险是窦性心律患者的五倍。口服抗凝剂如维生素K拮抗剂或非维生素K口服抗凝剂可有效预防中风。预防房颤患者中风的另一种方法是用经皮闭合系统闭合左心耳。PROTECT-AF和PREVAIL两项大型随机研究未能显示房颤患者左心耳封堵术优于抗凝治疗。然而，研究和登记的荟萃分析表明，左心耳闭合术在减少严重出血并发症方面具有特殊优势。目前，正在不同的患者群体中进行几项前瞻性随机研究，以评估左心耳封堵术与标准护理相比的益处。目前，建议颅内出血、晚期肾功能衰竭、严重胃肠道出血、复发性缺血性卒中高危患者以及出血和跌倒高危老年患者采用左心耳封堵术。

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来源期刊

Future Neurology CLINICAL NEUROLOGY-

CiteScore

2.10

自引率

0.00%

发文量

期刊介绍： The neurological landscape is changing rapidly. From the technological perspective, advanced molecular approaches and imaging modalities have greatly increased our understanding of neurological disease, with enhanced prospects for effective treatments in common but very serious disorders such as stroke, epilepsy, multiple sclerosis and Parkinson’s disease. Nevertheless, at the same time, the healthcare community is increasingly challenged by the rise in neurodegenerative diseases consequent upon demographic changes in developed countries.