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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

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The cessation of oral anticoagulation following left atrial appendage surgery

Neil Mangrolia1, Prakash Punjabi1

  • 1NHLI Cardiothoracic Surgery, B Block BN2/15, Hammersmith Hospital Campus, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0NN, England.

Future Cardiology
|September 21, 2018
PubMed

Insights

For patients with atrial fibrillation and bleeding risks, discontinuing oral anticoagulation after left atrial appendage closure may be safe. Evidence comparing surgical and percutaneous closure guides this decision.

Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Atrial fibrillation (AF) increases stroke risk, managed by oral anticoagulation (OAC).
  • OAC risks, particularly bleeding, can outweigh benefits in some patients.
  • Left atrial appendage (LAA) closure is an alternative strategy.

Purpose of the Study:

  • To review evidence on discontinuing OAC after surgical LAA closure in AF patients.
  • To compare safety and efficacy with percutaneous LAA closure data.

Main Methods:

  • Literature review of studies on LAA closure (surgical and percutaneous).
  • Analysis of evidence regarding OAC cessation post-procedure.
  • Comparison of outcomes between surgical and percutaneous LAA closure.

Main Results:

  • Percutaneous LAA closure studies suggest rationale for OAC discontinuation.
  • Clinical concern exists regarding OAC cessation safety after surgical LAA closure.
  • Evidence synthesis is needed to guide management decisions.

Conclusions:

  • Management of oral anticoagulation after left atrial appendage closure requires careful consideration.
  • Further evidence is needed to establish definitive guidelines for OAC cessation post-surgical LAA closure.

Keywords:
AmplatzerAtriClipLariatWATCHMANatrial fibrillationbleedingcardiac surgeryleft atrial appendageprophylaxisthromboembolism

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