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Postprocedural Management: Anticoagulation and Beyond.

Moniek Maarse1, Martin J Swaans1, Lucas V A Boersma2

  • 1Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435CM Nieuwegein, The Netherlands.

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|February 19, 2020
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Summary
This summary is machine-generated.

Excluding the left atrial appendage reduces stroke risk in nonvalvular atrial fibrillation. However, closure devices may cause thrombus, necessitating tailored antithrombotic therapy based on individual patient risks.

Keywords:
Anti-platelet therapyDevice related thrombusLeft atrial appendage closureOral anticoagulationStrokeThromboembolic complications

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Area of Science:

  • Cardiology
  • Vascular Surgery

Background:

  • Left atrial appendage exclusion is a strategy to mitigate stroke risk in nonvalvular atrial fibrillation.
  • Closure devices are exposed to blood flow during endothelialization, potentially activating coagulation and leading to device-related thrombus.

Purpose of the Study:

  • To evaluate the risks and benefits of antithrombotic treatment following left atrial appendage closure.
  • To explore alternative antithrombotic strategies for patients with contraindications to standard anticoagulation.

Main Methods:

  • Review of existing literature on left atrial appendage closure devices and antithrombotic therapies.
  • Analysis of patient/procedural characteristics influencing thromboembolic and bleeding risks.

Main Results:

  • Device-related thrombus is a potential complication requiring antithrombotic treatment.
  • Standard antithrombotic protocols may not be suitable for all patients, particularly those with anticoagulation contraindications.
  • Less intensive antithrombotic regimens show promise but require further investigation.

Conclusions:

  • A personalized antithrombotic treatment approach, balancing bleeding and thromboembolic risks, is likely optimal for patients undergoing left atrial appendage closure.
  • Further research is needed to define the best antithrombotic strategies for diverse patient populations.