TOPLINE:
Left atrial appendage closure was associated with about half as many disabling or fatal strokes and lower mortality after a stroke compared with dual oral anticoagulant therapy in patients with atrial fibrillation (AF), new observational research shows.
METHODOLOGY:
The retrospective registry analysis included 447 adult patients with nonvalvular AF, mean age 74 years, who were hospitalized with an ischemic stroke (IS), 322 of whom were receiving direct oral anticoagulant (DOAC) therapy, mostly (84%) apixaban or rivaroxaban, and 125 were treated with left atrial appendage closure (LAAC), almost all (97%) with Watchman or Watchman-FLX devices.
All patients received standard stroke care, monitoring, and treatment as well as physical therapy/rehabilitation.
For the primary outcome, researchers used the modified Rankin Scale (mRS) to determine disabling (mRS score of 3-5) and fatal (mRS score of 6) strokes at discharge and at 3 months.
The study adjusted for age, smoking, paroxysmal AF, prior major bleeding, prior hemorrhagic stroke, medication adherence, and other risk factors.
TAKEAWAY:
The incidence of disabling or fatal IS was significantly lower with LAAC vs with DOAC at discharge (38.3% vs 70.3%; P < .001) and at 3 months (33.3% vs 56.2%; P < .001), even though the LAAC group had more baseline comorbidity, for example, older age, more smokers, and more prior major bleeding.
