STROKE RISK FACTORS
Atrial fibrillation (AF) is associated with a 5-fold increase in the risk of ischemic stroke.1 Left atrial appendage (LAA) closure reduces the risk of stroke in non-valvular AF patients (NVAF) who are seeking an alternative to oral anticoagulants.2,3
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AF AND THE LEFT ATRIAL APPENDAGE
Because the upper chambers of the heart (atria) are unable to contract properly in patients with atrial fibrillation (AF), clots are able to form. A common site for clot formation is the left atrial appendage (LAA), which is attached to the left atrium. More than 90% of strokes in people with non-valvular AF (NVAF) are caused by blood clots formed in the LAA.4,5
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AF AND THE CHALLENGES OF MEDICATION
Many patients at risk of stroke want an alternative to oral anticoagulants (OACs), for example, warfarin and non-vitamin K oral anticoagulants (NOACs).6
CHALLENGES OF NOACS AND WARFARIN INCLUDE:6,8
- Significant bleeding risks
- Significant non-compliance rates
- Regular international normalized ratio (INR) monitoring (warfarin)
- Food and drug interaction issues (warfarin)
- Complicates surgical procedures
- High cost (NOACs)
LAA OCCLUSION IS AN ALTERNATIVE TO LONG-TERM MEDICATION FOR REDUCING RISK OF STROKE
Surgery to remove or tie off the LAA is highly invasive.
- Typically reserved for patients undergoing cardiac surgery for concomitant conditions
- Complete closure rates range from 0% to 100%6
Transcatheter occlusion of the LAA is minimally invasive.
- Closure rates are 98.9% with the Amplatzer™ Amulet™ LAA Occluder2,3
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- Amplatzer™ Amulet™ LAA Occluder Instructions for Use.
- Lakkireddy D, Thaler D, Ellis CR, et al. Amplatzer Amulet Left Atrial Appendage Occluder versus Watchman device for stroke prophylaxis (Amulet IDE): A randomized controlled trial. Circulation. 2021; 144(19):1543–1552. doi.org/10.1161/CIRCULATIONAHA.121.057063.
- Suradi HS, Hijazi ZM. Left atrial appendage closure: outcomes and challenges. Neth Heart J. 2017;25(2):143–151. doi.org/10.1007/s12471-016-0929-0.
- Kakkar AK, Mueller I, Bassand JP, et al. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PLOS ONE. 2013;8(5):e63479. doi.org/10.1371/journal.pone.0063479.
- Baman JR, Mansour M, Heist EK, et al. Percutaneous left atrial appendage occlusion in the prevention of stroke in atrial fibrillation: a systematic review. Heart Fail Rev. 2018;23(2):191–208. doi.org/10.1007/s10741-018-9681-4.
- European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery; Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369–429. doi.org/10.1093/eurheartj/ehq278. Erratum in: Eur Heart J. 2011;32(9):1172. PMID: 20802247.