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Percutaneous left atrial appendage occlusion: A review of current devices, clinical evidence, patient selection, and post procedural antithrombotic management
Progress in Cardiovascular Diseases ( IF 9.1 ) Pub Date : 2021-07-28 , DOI: 10.1016/j.pcad.2021.06.006
Larry R Jackson 1 , Kevin P Jackson 2 , Kevin L Thomas 1
Affiliation  

Stroke is a major driver of increased morbidity and mortality in patients with non-valvular atrial fibrillation (NVAF). While systemic oral anticoagulation (OAC) continues to be the mainstay for stroke reduction therapy in patients with NVAF, several barriers prevent the sustained long-term use of OAC, including increased risk of bleeding, non-compliance, cost, drug-drug interactions, and the need for ongoing laboratory testing. Given the need for continued stroke reduction therapies in patients who are intolerant of or non-compliant with OAC, percutaneous left atrial appendage (LAA) occlusion (LAAO) has emerged as a nonpharmacologic alternative to OAC. The development of percutaneous LAAO techniques is based on data suggesting that more than 90% of thrombi in patients with NVAF originate in the LAA. Two percutaneous LAAO devices are currently in widespread clinical use: Watchman (United States and Europe) and the Amplatzer type of devices (Europe); randomized trial data exist only for the Watchman device. Multiple randomized and nonrandomized trials and registries have demonstrated the safety and effectiveness of LAAO in patients who are suitable for short-term anticoagulation using a variety of post-procedural antithrombotic strategies. Ongoing randomized clinical trials on LAAO are focused on OAC-ineligible patients to compare efficacy of LAAO devices against a multitude of antithrombotic options. This review aims to discuss the rationale and evidence for LAAO and post procedural antithrombotic strategies and opportunities for research examination. In addition, we discuss the need for continued investigation of LAAO in populations not well represented in clinical trials or registries, including women, older patients, and underrepresented racial and ethnic groups.



中文翻译:

经皮左心耳封堵术:对当前装置、临床证据、患者选择和术后抗血栓管理的回顾

中风是非瓣膜性心房颤动 (NVAF) 患者发病率和死亡率增加的主要原因。虽然全身口服抗凝药 (OAC) 仍然是 NVAF 患者减少卒中治疗的主要方法,但有几个障碍阻碍了 OAC 的持续长期使用,包括出血风险增加、不依从性、成本、药物间相互作用、以及持续进行实验室测试的必要性。鉴于对 OAC 不耐受或不依从的患者需要持续减少卒中治疗,经皮左心耳 (LAA) 封堵术 (LAAO) 已成为 OAC 的非药物替代方法。经皮 LAAO 技术的发展基于表明 NVAF 患者中超过 90% 的血栓起源于 LAA 的数据。目前临床上广泛使用两种经皮 LAAO 装置:Watchman(美国和欧洲)和 Amplatzer 型装置(欧洲);随机试验数据仅适用于 Watchman 设备。多项随机和非随机试验和注册已经证明了 LAAO 在适合使用各种术后抗血栓策略进行短期抗凝治疗的患者中的安全性和有效性。正在进行的关于 LAAO 的随机临床试验主要针对 OAC 不合格患者,以比较 LAAO 装置与多种抗血栓选择的疗效。本综述旨在讨论 LAAO 和术后抗血栓策略的基本原理和证据以及研究检查的机会。此外,

更新日期:2021-07-28
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