title: Ischaemic stroke prevention in patients with atrial fibrillation and high bleeding risk: opportunities and challenges for percutaneous left atrial appendage occlusion.
abstract: Patients with atrial fibrillation (AF) are at an increased risk of ischaemic stroke. The efficacy of stroke prevention with vitamin K antagonists in these patients has been well established. However, associated bleeding risks may offset the therapeutic benefits in patients with risk factors for bleeding. Despite improvements achieved by novel oral anticoagulants, bleeding remains a clinically relevant problem, especially gastrointestinal bleeding. Percutaneous occlusion of the left atrial appendage (LAA) may be considered as an alternative stroke prevention therapy in AF patients with a high bleeding risk. This paper explores patient groups in whom oral anticoagulation may be challenging and percutaneous LAA occlusion (LAAO) has a potentially better risk-benefit balance. The current status of LAAO and future directions are reviewed, and particular challenges for LAA occlusion requiring further clinical data are discussed. This article is a summary of the Third Global Summit on LAA occlusion, 15 March 2013, Barcelona, Spain.
authors.affiliation: Isar Heart Center Munich, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lewalter
authors.forename: P
authors.initials: P
authors.lastname: Kanagaratnam
authors.forename: B
authors.initials: B
authors.lastname: Schmidt
authors.forename: M
authors.initials: M
authors.lastname: Rosenqvist
authors.forename: J E
authors.initials: JE
authors.lastname: Nielsen-Kudsk
authors.forename: R
authors.initials: R
authors.lastname: Ibrahim
authors.forename: B A
authors.initials: BA
authors.lastname: Albers
authors.forename: A J
authors.initials: AJ
authors.lastname: Camm
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D057510:Endovascular Procedures / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Atrial fibrillation; Left atrial appendage occlusion; Stroke; bleeding