Prevention of Cardioembolic Complications in Patients with Atrial Fibrillation: Efficacy and Safety of Left Atrial Appendage Isolation and Oral Anticoagulants
Aim. To study the outcomes frequency and structure in patients with atrial fibrillation (AF) depending on the cardioembolic events preventing method: left atrial appendage (LAA) isolation, direct oral anticoagulants (DOACs) or warfarin.Material and methods. A prospective observational study included...
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Столичная издательская компания
2022-09-01
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| Series: | Рациональная фармакотерапия в кардиологии |
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| Online Access: | https://www.rpcardio.online/jour/article/view/2795 |
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| author | D. V. Pevzner N. S. Kostritca A. K. Alieva I. A. Merkulova I. S. Yavelov E. V. Merkulov I. E. Chazova |
| author_facet | D. V. Pevzner N. S. Kostritca A. K. Alieva I. A. Merkulova I. S. Yavelov E. V. Merkulov I. E. Chazova |
| author_sort | D. V. Pevzner |
| collection | DOAJ |
| description | Aim. To study the outcomes frequency and structure in patients with atrial fibrillation (AF) depending on the cardioembolic events preventing method: left atrial appendage (LAA) isolation, direct oral anticoagulants (DOACs) or warfarin.Material and methods. A prospective observational study included patients with AF and high risk of cardioembolic complications and without contraindications to anticoagulants. Patients who refused long-term oral anticoagulants taking underwent LAA isolation, the rest of the patients received DOACs or warfarin. The observation period was 3 years. Mortality, cardioembolic complications and major bleeding (according to GARFIELD criteria) cumulative incidence was assessed.Results. We included 245 patients: 46 patients were treated with LAA isolation, 100 with warfarin, and 99 with DOACs. Multivariate regression analysis demonstrated a statistically significant advantage of LAA occluder in terms of combined endpoint achieving frequency compared to warfarin (hazard ratio [HR] 3.10; 95% confidence interval [CI] 1.01-9.54; p=0.049), and to DOACs (HR 3.44, 95% CI 1.15-10.29; p=0.027). A similar result was obtained for all-cause mortality (HR 5.24; 95% CI 1.12-24.55; p=0.036 and HR 5.58; 95% CI 1.22-25.49; p=0.027, respectively). There were no significant differences in bleeding rates between the groups.Conclusion. This observational study demonstrates the superiority of LAA isolation as a first-line therapy over DOACs and warfarin in patients with AF and high risk of cardioembolic complications. Randomized trials are required to confirm these observations. |
| format | Article |
| id | doaj-art-e19daf7cf2464a9ea776df3c8cd08ebd |
| institution | Kabale University |
| issn | 1819-6446 2225-3653 |
| language | English |
| publishDate | 2022-09-01 |
| publisher | Столичная издательская компания |
| record_format | Article |
| series | Рациональная фармакотерапия в кардиологии |
| spelling | doaj-art-e19daf7cf2464a9ea776df3c8cd08ebd2025-08-23T10:00:35ZengСтоличная издательская компанияРациональная фармакотерапия в кардиологии1819-64462225-36532022-09-0118443944810.20996/1819-6446-2022-08-092051Prevention of Cardioembolic Complications in Patients with Atrial Fibrillation: Efficacy and Safety of Left Atrial Appendage Isolation and Oral AnticoagulantsD. V. Pevzner0N. S. Kostritca1A. K. Alieva2I. A. Merkulova3I. S. Yavelov4E. V. Merkulov5I. E. Chazova6National Medical Research Centre of Cardiology named after academician E.I. ChazovNational Medical Research Centre of Cardiology named after academician E.I. ChazovNational Medical Research Centre of Cardiology named after academician E.I. ChazovNational Medical Research Centre of Cardiology named after academician E.I. ChazovFederal State Budgetary Institution National Medical Research Centre for Therapy and Preventive Medicine of the Ministry of Health of the Russian FederationNational Medical Research Centre of Cardiology named after academician E.I. ChazovNational Medical Research Centre of Cardiology named after academician E.I. ChazovAim. To study the outcomes frequency and structure in patients with atrial fibrillation (AF) depending on the cardioembolic events preventing method: left atrial appendage (LAA) isolation, direct oral anticoagulants (DOACs) or warfarin.Material and methods. A prospective observational study included patients with AF and high risk of cardioembolic complications and without contraindications to anticoagulants. Patients who refused long-term oral anticoagulants taking underwent LAA isolation, the rest of the patients received DOACs or warfarin. The observation period was 3 years. Mortality, cardioembolic complications and major bleeding (according to GARFIELD criteria) cumulative incidence was assessed.Results. We included 245 patients: 46 patients were treated with LAA isolation, 100 with warfarin, and 99 with DOACs. Multivariate regression analysis demonstrated a statistically significant advantage of LAA occluder in terms of combined endpoint achieving frequency compared to warfarin (hazard ratio [HR] 3.10; 95% confidence interval [CI] 1.01-9.54; p=0.049), and to DOACs (HR 3.44, 95% CI 1.15-10.29; p=0.027). A similar result was obtained for all-cause mortality (HR 5.24; 95% CI 1.12-24.55; p=0.036 and HR 5.58; 95% CI 1.22-25.49; p=0.027, respectively). There were no significant differences in bleeding rates between the groups.Conclusion. This observational study demonstrates the superiority of LAA isolation as a first-line therapy over DOACs and warfarin in patients with AF and high risk of cardioembolic complications. Randomized trials are required to confirm these observations.https://www.rpcardio.online/jour/article/view/2795atrial fibrillationleft atrial appendage occluderdirect oral anticoagulantscardioembolic complications |
| spellingShingle | D. V. Pevzner N. S. Kostritca A. K. Alieva I. A. Merkulova I. S. Yavelov E. V. Merkulov I. E. Chazova Prevention of Cardioembolic Complications in Patients with Atrial Fibrillation: Efficacy and Safety of Left Atrial Appendage Isolation and Oral Anticoagulants Рациональная фармакотерапия в кардиологии atrial fibrillation left atrial appendage occluder direct oral anticoagulants cardioembolic complications |
| title | Prevention of Cardioembolic Complications in Patients with Atrial Fibrillation: Efficacy and Safety of Left Atrial Appendage Isolation and Oral Anticoagulants |
| title_full | Prevention of Cardioembolic Complications in Patients with Atrial Fibrillation: Efficacy and Safety of Left Atrial Appendage Isolation and Oral Anticoagulants |
| title_fullStr | Prevention of Cardioembolic Complications in Patients with Atrial Fibrillation: Efficacy and Safety of Left Atrial Appendage Isolation and Oral Anticoagulants |
| title_full_unstemmed | Prevention of Cardioembolic Complications in Patients with Atrial Fibrillation: Efficacy and Safety of Left Atrial Appendage Isolation and Oral Anticoagulants |
| title_short | Prevention of Cardioembolic Complications in Patients with Atrial Fibrillation: Efficacy and Safety of Left Atrial Appendage Isolation and Oral Anticoagulants |
| title_sort | prevention of cardioembolic complications in patients with atrial fibrillation efficacy and safety of left atrial appendage isolation and oral anticoagulants |
| topic | atrial fibrillation left atrial appendage occluder direct oral anticoagulants cardioembolic complications |
| url | https://www.rpcardio.online/jour/article/view/2795 |
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