Severity of Ischemic Stroke After Left Atrial Appendage Closure vs Nonwarfarin Oral Anticoagulants

被引:7
|
作者
Turagam, Mohit K. [1 ]
Kawamura, Iwanari [1 ]
Neuzil, Petr [2 ]
Nair, Devi [3 ]
Doshi, Shephal [4 ]
Valderrabano, Miguel [5 ]
Hala, Pavel [2 ]
Della Rocca, Domenico [6 ]
Gibson, Douglas [7 ]
Funasako, Moritoshi [2 ]
Ha, Grace [8 ]
Lee, Bridget [3 ]
Musikantow, Daniel [1 ]
Yoo, David [7 ]
Flautt, Thomas [5 ]
Dukkipati, Srinivas [1 ]
Natale, Andrea [6 ]
Gurol, Mahmut E. [8 ]
Halperin, Jonathan [1 ]
Mansour, Moussa [8 ]
Reddy, Vivek Y. [1 ,9 ]
机构
[1] Icahn Sch Med Mt Sinai, New York, NY USA
[2] Homolka Hosp, Prague, Czech Republic
[3] St Bernards Heart & Vasc Ctr, Jonesboro, AR USA
[4] Pacific Heart Inst, Santa Monica, CA USA
[5] Houston Methodist, Houston, TX USA
[6] Texas Cardiac Arrhythmia Inst, Houston, TX USA
[7] Scripps Hlth, San Diego, CA USA
[8] Massachusetts Gen Hosp, Boston, MA USA
[9] Icahn Sch Med Mt Sinai, Helmsley Electrophysiol Ctr, One Gustave L Levy Pl, Box 1030, New York, NY 10029 USA
关键词
anticoagulation; atrial fibrillation; left atrial appendage closure; non-vitamin K oral antagonist; Rankin scale; stroke; HEMORRHAGIC TRANSFORMATION; ANTITHROMBOTIC TREATMENT; FIBRILLATION; OCCLUSION; OUTCOMES; METAANALYSIS; ASSOCIATION;
D O I
10.1016/j.jacep.2023.10.012
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Strokes after left atrial appendage closure (LAAC) prophylaxis are generally less severe than those after warfarin prophylaxis-thought to be secondary to more hemorrhagic strokes with warfarin. Hemorrhagic strokes are similarly infrequent with direct oral anticoagulant (DOAC) prophylaxis, so the primary subtype after either LAAC or DOAC prophylaxis is ischemic stroke (IS). Objectives: The purpose of this study was to compare the severity of IS using the modified Rankin Scale in atrial fibrillation patients receiving prophylaxis with DOACs vs LAAC. Methods: A retrospective analysis was performed of consecutive patients undergoing LAAC at 8 centers who developed an IS (ISLAAC) compared with contemporaneous consecutive patients who developed IS during treatment with DOACs (ISDOAC). The primary outcome was disabling/fatal stroke (modified Rankin Scale 3-5) at discharge and 3 months later. Results: Compared with ISDOAC patients (n = 322), ISLAAC patients (n = 125) were older (age 77.2 +/- 13.4 years vs 73.1 +/- 11.9 years; P = 0.002), with higher HAS-BLED scores (3.0 vs 2.0; P = 0.004) and more frequent prior bleeding events (54.4% vs 23.6%; P < 0.001), but similar CHA(2)DS(2)-VASc scores (5.0 vs 5.0; P = 0.28). Strokes were less frequently disabling/fatal with ISLAAC than ISDOAC at both hospital discharge (38.3% vs 70.3%; P < 0.001) and 3 months later (33.3% vs 56.2%; P < 0.001). Differences in stroke severity persisted after propensity score matching. By multivariate regression analysis, ISLAAC was independently associated with fewer disabling/fatal strokes at discharge (OR: 0.22; 95% CI: 0.13-0.39; P < 0.001) and 3 months (OR: 0.25; 95% CI: 0.12-0.50; P < 0.001), and fewer deaths at 3 months (OR: 0.28; 95% CI: 0.12-0.64; P < 0.001). Conclusions: Ischemic strokes in patients with atrial fibrillation are less often disabling or fatal with LAAC than DOAC prophylaxis.
引用
收藏
页码:270 / 283
页数:14
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