The cessation of oral anticoagulation following left atrial appendage surgery

Future Cardiology
Neil Mangrolia, Prakash Punjabi

Abstract

Atrial fibrillation is associated with a significantly increased risk of stroke, and oral anticoagulation is the mainstay of preventative treatment. Scenarios arise where the risks of treatment with oral anticoagulation may outweigh the benefits, most commonly when there is an elevated risk of bleeding. Studies of percutaneous closure of the left atrial appendage have strongly implicated this structure in the etiology of stroke in atrial fibrillation, and provide some rationale for the discontinuation of oral anticoagulation following percutaneous closure device implantation. A common clinical concern is the safety of cessation of oral anticoagulation after surgical closure of the left atrial appendage in patients with a history of atrial fibrillation. Here, we review the evidence guiding this management decision and draw comparison with data on percutaneous closure.

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Methods Mentioned

BETA
coronary artery bypass

Clinical Trials Mentioned

NCT02701062
NCT02478294

Software Mentioned

PREVAIL
PROTECT
AF
AtriClip

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