Left atrial appendage occlusion for stroke despite oral anticoagulation (resistant stroke). Results from the Amplatzer Cardiac Plug registry: Cierre de la orejuela izquierda por ictus pese a la anticoagulación oral (ictus resistente): resultados del registro Amplatzer Cardiac Plug

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Ignacio Cruz-González, Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), CIBERCV, Salamanca, Spain.
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  • Rocío González-Ferreiro, Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), CIBERCV, Salamanca, Spain.
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  • Xavier Freixa, Servicio de Cardiologia, Hospital Clínico, Universidad de Barcelona, Barcelona, Spain.
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  • Sameer Gafoor, Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany.
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  • Samera Shakir, Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; and.
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  • Heyder Omran, Department of Cardiology, University Hospital of Bonn, Bonn, Germany.
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  • Sergio Berti, Department of Cardiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy.
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  • Gennaro Santoro, Department of Cardiology, Ospedale Careggi di Firenze, Florence, Italy.
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  • Joelle Kefer, Department of Cardiology, St-Luc University Hospital, Brussels, Belgium.
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  • Ulf Landmesser, Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland.
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  • Jens Erik Nielsen-Kudsk
  • Prapa Kanagaratnam, Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
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  • Fabian Nietlispach, Department of Cardiology, University Hospital of Bern, Bern, Switzerland., Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland.
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  • Steffen Gloekler, Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
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  • Adel Aminian, Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
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  • Paolo Danna, Department of Cardiology, Ospedale Luigi Sacco, Milan, Italy.
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  • Marco Rezzaghi, Department of Cardiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy.
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  • Friederike Stock, Department of Cardiology, University Hospital of Bonn, Bonn, Germany.
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  • Miroslava Stolcova, Department of Cardiology, Ospedale Careggi di Firenze, Florence, Italy.
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  • Luis Paiva, Department of Cardiology, Coimbra University Hospital Centre, Coimbra, Portugal.
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  • Marco Costa, Department of Cardiology, Coimbra University Hospital Centre, Coimbra, Portugal.
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  • Xavier Millán, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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  • Reda Ibrahim, Department of Cardiology, Montreal Heart Institute, Montreal, Canada.
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  • Tobias Tichelbäcker, Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Heart Center Cologne, Cologne, Germany.
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  • Wolfgang Schillinger, Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Heart Center Cologne, Cologne, Germany.
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  • Jai-Wun Park, Department of Cardiology, Coburg Hospital, Coburg, Germany.
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  • Horst Sievert, Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany.
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  • Bernhard Meier, Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
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  • Apostolos Tzikas, Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.

INTRODUCTION AND OBJECTIVES: Despite the efficacy of oral anticoagulant (OAC) therapy, some patients continue to have a high residual risk and develop a stroke on OAC therapy (resistant stroke [RS]), and there is a lack of evidence on the management of these patients. The aim of this study was to analyze the safety and efficacy of left atrial appendage occlusion (LAAO) as secondary prevention in patients with nonvalvular atrial fibrillation who have experienced a stroke/transient ischemic attack despite OAC treatment.

METHODS: We analyzed data from the Amplatzer Cardiac Plug multicenter registry on 1047 consecutive patients with nonvalvular atrial fibrillation undergoing LAAO. Patientes with previous stroke on OAC therapy as indication for LAAO were identified and compared with patients with other indications.

RESULTS: A total of 115 patients (11%) with RS were identified. The CHA2DS2-VASc and the HAS-BLED score were significantly higher in the RS group (respectively 5.5±1.5 vs 4.3±1.6; P <.001; 3.9±1.3 vs 3.1±1.2; P <.001). No significant differences were observed in periprocedural major safety events (7.8 vs 4.5%; P=.1). With a mean clinical follow-up of 16.2±12.2 months, the observed annual stroke/transient ischemic attack rate for the RS group was 2.6% (65% risk reduction) and the observed annual major bleeding rate was 0% (100% risk reduction).

CONCLUSIONS: Patients with RS undergoing LAAO showed similar safety outcomes to patients without RS, with a significant reduction in stroke/transient ischemic attack and major bleeding events during follow-up. Adequately powered controlled trials are needed to further investigate the use of LAAO in RS patients.

Original languageEnglish
JournalRevista española de cardiología (English ed.)
Volume73
Issue1
Pages (from-to)28-34
Number of pages7
DOIs
Publication statusPublished - Jan 2020

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