Radoslaw Litwinowicz1, Magdalena Bartus2, Michalina Malec-Litwinowicz3, Michal Michalski3, Krzysztof Banaszkiewicz3, Boguslaw Kapelak4, Dhanunjaya Lakkireddy5, Krzysztof Bartus4. 1. Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland, radek.litwinowicz@gmail.com. 2. Department of Pharmacology, Jagiellonian University, Krakow, Poland. 3. Department of Neurology, John Paul II Hospital, Krakow, Poland. 4. Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland. 5. The Kansas City Heart Rhythm Institute, Overland Park, Kansas City, Missouri, USA.
Abstract
BACKGROUND: Patients surviving an initial stroke present a significantly increased risk for further strokes. Left atrial appendage closure (LAAC) became an alternative treatment to pharmacological therapy for stroke prevention in atrial fibrillation (AF) patients. OBJECTIVE: To evaluate the long-term efficacy of LAAC in primary and secondary stroke prevention in patients with AF. METHODS: This retrospective study enrolled 139 patients following LAAC who were divided into 2 groups: 37 patients with prior stroke (Stroke Group) and 102 patients without stroke (Control Group). Overall, cumulative follow-up was 530.1 patient-years. RESULTS: Mean CHADS2, CHA2DS2-VASc scores, and HAS-BLED score were higher in patients with prior stroke compared to patients without stroke (3.0 vs. 1.4, p < 0.0001 and 4.6 vs. 2.3, p < 0.0001, 4.0 vs. 2.8, p < 0.0001, respectively). There were no significant differences between other patient factors (sex, heart failure, hypertension, previous stroke/transient ischemic attack, peripheral vascular disease), which may increase the risk of thromboembolism based on the CHA2DS2-VASc score. Average follow-up was 51.3 months in patients with previous stroke and 50 months in patients without previous stroke. Thromboembolic event rate was 0.8 vs. 0.5 (p = 0.72), bleeding event rate was 0 years vs. 1.4 (p = 0.25), and mortality rates were 0.8 vs. 2.1 (p = 0.38) between the Stroke Group and the Control Group. The estimated reductions in thromboembolic and bleeding risks were 89 and 100%, respectively, in Stroke Group, and 91 and 81%, respectively, in Control Group. CONCLUSION: Patients with prior stroke may be the preferred group for LAAC regardless of the presence or absence of contraindications for anticoagulant therapy.
BACKGROUND:Patients surviving an initial stroke present a significantly increased risk for further strokes. Left atrial appendage closure (LAAC) became an alternative treatment to pharmacological therapy for stroke prevention in atrial fibrillation (AF) patients. OBJECTIVE: To evaluate the long-term efficacy of LAAC in primary and secondary stroke prevention in patients with AF. METHODS: This retrospective study enrolled 139 patients following LAAC who were divided into 2 groups: 37 patients with prior stroke (Stroke Group) and 102 patients without stroke (Control Group). Overall, cumulative follow-up was 530.1 patient-years. RESULTS: Mean CHADS2, CHA2DS2-VASc scores, and HAS-BLED score were higher in patients with prior stroke compared to patients without stroke (3.0 vs. 1.4, p < 0.0001 and 4.6 vs. 2.3, p < 0.0001, 4.0 vs. 2.8, p < 0.0001, respectively). There were no significant differences between other patient factors (sex, heart failure, hypertension, previous stroke/transient ischemic attack, peripheral vascular disease), which may increase the risk of thromboembolism based on the CHA2DS2-VASc score. Average follow-up was 51.3 months in patients with previous stroke and 50 months in patients without previous stroke. Thromboembolic event rate was 0.8 vs. 0.5 (p = 0.72), bleeding event rate was 0 years vs. 1.4 (p = 0.25), and mortality rates were 0.8 vs. 2.1 (p = 0.38) between the Stroke Group and the Control Group. The estimated reductions in thromboembolic and bleeding risks were 89 and 100%, respectively, in Stroke Group, and 91 and 81%, respectively, in Control Group. CONCLUSION:Patients with prior stroke may be the preferred group for LAAC regardless of the presence or absence of contraindications for anticoagulant therapy.
Authors: Karolina Pawelkowska; Stanislaw Bartus; Robert Sobczynski; Michal Medrzycki; Grzegorz Grudzien; Grzegorz Filip; Bartosz Cierpikowski; Krzysztof Bartus; Boguslaw Kapelak Journal: Kardiochir Torakochirurgia Pol Date: 2022-01-09
Authors: Chad A Krueger; Michael Yayac; Chris Vannello; John Wilsman; Matthew S Austin; P Maxwell Courtney Journal: J Arthroplasty Date: 2020-10-26 Impact factor: 4.757