Left Atrial Appendage Closure Beneficial in Nonvalvular A-Fib
(HealthDay News) — For patients with nonvalvular atrial fibrillation (NVAF), left atrial appendage closure (LAAC) is associated with reduced rates of hemorrhagic stroke, cardiovascular/unexplained death, and nonprocedural bleeding vs. warfarin. The findings were published in the June 23 issue of the Journal of the American College of Cardiology.
David R. Holmes Jr., MD, from the Mayo Clinic in Rochester, MN, and colleagues examined composite data regarding LAAC vs. warfarin in two randomized trials that involved 2,406 patients with NVAF. Patients were followed for a mean of 2.69 years, with 5,931 patient-years of follow-up.
The researchers found that patients receiving LAAC with the Watchman device vs. warfarin had significantly fewer hemorrhagic strokes (hazard ratio [HR], 0.22; P=0.004), cardiovascular/unexplained deaths (HR, 0.48; P=0.006), and nonprocedural bleeding (HR, 0.51; P=0.006). Both strategies had similar rates of all-cause stroke or systemic embolism (HR, 1.02; 95% confidence interval, 0.62–1.7; P=0.94). There was an increased risk of ischemic strokes seen within the device group (HR, 1.95; P=0.05).
"In patients with NVAF at increased risk for stroke or bleeding who are candidates for chronic anticoagulation, LAAC resulted in improved rates of hemorrhagic stroke, cardiovascular/unexplained death, and nonprocedural bleeding compared to warfarin," the authors write.
Several authors disclosed financial ties to the pharmaceutical and medical device industries. One author and his institution disclosed financial ties to the technology related to this study, which has been licensed to Boston Scientific.