Clinical follow-up of left atrial appendage occlusion in patients with atrial fibrillation ineligible of oral anticoagulation treatment-a systematic review and meta-analysis.

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Abstrakt

Tytuł:: Clinical follow-up of left atrial appendage occlusion in patients with atrial fibrillation ineligible of oral anticoagulation treatment-a systematic review and meta-analysis.
Autorzy:: Labori F; Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 463, 405 30, Gothenburg, Sweden. .
Bonander C; Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 463, 405 30, Gothenburg, Sweden.
Persson J; Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 463, 405 30, Gothenburg, Sweden.
Svensson M; Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 463, 405 30, Gothenburg, Sweden.
Źródło:: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2021 Aug; Vol. 61 (2), pp. 215-225. Date of Electronic Publication: 2021 Feb 13.
Typ publikacji:: Journal Article; Meta-Analysis; Review; Systematic Review
Język:: English
Imprint Name(s):: Publication: Amsterdam : Springer
Original Publication: Norwell, MA : Kluwer Academic Publishers, c1997-
MeSH Terms:: Atrial Appendage*/diagnostic imaging
Atrial Appendage*/surgery
Atrial Fibrillation*/drug therapy
Stroke*/epidemiology
Stroke*/prevention & control
Anticoagulants ; Follow-Up Studies ; Humans ; Observational Studies as Topic ; Treatment Outcome
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Contributed Indexing:: Keywords: Atrial fibrillation; Contraindication; Ischemic stroke; Left atrial appendage closure; Left atrial appendage occlusion; Systematic review
Substance Nomenclature:: 0 (Anticoagulants)
Entry Date(s):: Date Created: 20210213 Date Completed: 20210818 Latest Revision: 20231107
Update Code:: 20240104
PubMed Central ID:: PMC8324592
DOI:: 10.1007/s10840-021-00953-9
PMID:: 33580847
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Purpose: The recommended stroke prevention for patients with atrial fibrillation (AF) and increased risk of ischemic stroke is oral anticoagulation (OAC). Parts of the patient population are not eligible due to contraindication, and percutaneous left atrial occlusion (LAAO) can then be a preventive treatment option. The aim of this systematic review and meta-analysis is to estimate the long-term clinical effectiveness of LAAO as stroke prevention in patients with AF, increased risk of ischemic stroke, and contraindication to OAC.
Methods: We performed a systematic review and meta-analysis, using Poisson random effect models, to estimate the incidence rate (events per 100 patient-years) of ischemic stroke, transient ischemic attack, major bleeding, and all-cause death after LAAO treatment. We also calculated the risk reduction of ischemic stroke with LAAO compared with no stroke prevention estimated through a predicted risk in an untreated population (5.5 per 100 patient-years).
Results: We included 29 observational studies in our meta-analysis, including 7 951 individuals and 12 211 patient-years. The mean CHA 2 DS 2 -VASc score among the patients in the included studies is 4.32. The pooled incidence rate of ischemic stroke is 1.38 per 100 patient-years (95% CI 1.08; 1.77). According to a meta-regression model, the estimated incidence rate of ischemic stroke at CHA 2 DS 2 -VASc 4 is 1.39 per 100 patient-years. This implies a risk reduction of 74.7% with LAAO compared to predicated risk with no stroke prevention.
Conclusions: Our results suggest that LAAO is effective as stroke prevention for patients with AF, increased risk of stroke, and contraindication to oral anticoagulation.
(© 2021. The Author(s).)

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