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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(03): 219-222
DOI: 10.1590/0004-282X20150210
ARTICLE

Left atrial appendage occlusion with Amplatzer Cardio Plug is an acceptable therapeutic option for prevention of stroke recurrence in patients with non-valvular atrial fibrillation and contraindication or failure of oral anticoagulation with acenocumarol

La oclusión de la orejuela izquierda con Amplatzer Cardio Plug es una terapia aceptable para prevención del ACV isquémico en pacientes con fibrilación auricular y contraidicación o falla terapéutica con acenocumarol
Maximiliano A. Hawkes
FLENI, Instituto de investigaciones Neurologicas Raul Carrea, Departamento de Neurologia, Buenos Aires, Argentina.
,
Lucía Pertierra
FLENI, Instituto de investigaciones Neurologicas Raul Carrea, Departamento de Neurologia, Buenos Aires, Argentina.
,
Federico Rodriguez-Lucci
FLENI, Instituto de investigaciones Neurologicas Raul Carrea, Departamento de Neurologia, Buenos Aires, Argentina.
,
Virginia A. Pujol-Lereis
FLENI, Instituto de investigaciones Neurologicas Raul Carrea, Departamento de Neurologia, Buenos Aires, Argentina.
,
Sebastián F. Ameriso
FLENI, Instituto de investigaciones Neurologicas Raul Carrea, Departamento de Neurologia, Buenos Aires, Argentina.
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ABSTRACT

Left atrial appendage occlusion (LAAO) appears as a therapeutic option for some atrial fibrillation patients not suitable for oral anticoagulation because an increased hemorrhagic risk or recurrent ischemic events despite anticoagulant treatment.

Methods Report of consecutive atrial fibrillation patients treated with LAAO with Amplatzer Cardio Plug because contraindication or failure of oral anticoagulation with acenocumarol. CHA2DS2VASC, HAS-BLED, NIHSS, mRS, procedural complications and outcome were assessed. Seven patients (73 ± 6 year-old) were treated after intracerebral (n = 5) and gastrointestinal (n = 1) hemorrhages or ischemic stroke recurrence while on acenocumarol (n = 1).

Results Mean follow up was 18 months. Baseline CHA2DS2Vasc y HAS-BLED scores were 5.6 ± 0.7 and 4.1 ± 0.3 respectively. There were no strokes or deaths. There was only one non-serious adverse event.

Conclusion LAAO with ACP appears as a feasible therapeutic option for stroke prevention in patients with atrial fibrillation and failure or contraindication to acenocumarol.

RESUMEN

La oclusión de la orejuela auricular izquierda (OOAI) es una opción terapéutica en pacientes con fibrilación auricular y alto riesgo hemorrágico o recurrencia de accidente cerebrovascular isquémico (ACVi) a pesar del tratamiento anticoagulante.

Métodos Reporte de pacientes con fibrilación auricular y contraindicación o fallo terapéutico con acenocumarol tratados con OOAI. Se evaluaron escalas CHA2DS2VASC, HAS-BLED, NIHSS y mRS, complicaciones procedurales y resultados.

Resultados Siete pacientes (73 ± 6 años) fueron tratados luego de sufrir hemorragia cerebral (n = 5), gastrointestinal (n = 1) o ACVi recurrente a pesar del tratamiento con acenocumarol. Las escalas CHADS2VASC y HAS-BLED fueron 5.6 ± 0.7 y 4.1 ± 0.3 respectivamente. Luego de un seguimeinto promedio fue de 18 meses (3-50) no se registraron ACVi o muertes. Se registró sólo un evento adverso no serio.

Conclusión La OOAI es una opción terapéutica factible para prevenir ACVi en pacientes con fibrilación auricular y fallo o contraindicación para recibir acenocumarol.

atrial fibrillation - stroke recurrence - intracerebral hemorrhage - oral anticoagulants - Amplatzer Cardio Plug
fibrilación auricular - hemorragia intracerebral - anticoagulantes orales - Amplatzer Cardio Plug


Publikationsverlauf

Eingereicht: 07. Juli 2015

Angenommen: 04. November 2015

Artikel online veröffentlicht:
06. September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med. 2013;369(5):448-57. doi:10.1056/NEJMra1201534
  • 2 Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383(9913):245-54. doi:10.1016/S0140-6736(13)61953-4
  • 3 Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-8. doi:10.1161/01.STR.22.8.983
  • 4 Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly: the Framingham Study. Arch Intern Med. 1987;147(9):1561-4. doi:10.1001/archinte.1987.00370090041008
  • 5 Sakellaridis T, Argiriou M, Charitos C, Tsakiridis K, Zarogoulidis P. Left atrial appendage exclusion — Where do we stand? J Thorac Dis. 2014;6(Suppl 1):70-7. doi:10.3978/j.issn.2072-1439.2013.10.24
  • 6 Poli D, Antonucci E, Dentali F, Erba N, Testa S, Tiraferri E et al. Recurrence of ICH after resumption of anticoagulation with VK antagonists: CHIRONE study. Neurology. 2014;82(12):1020-6. doi:10.1212/WNL.20150210201502100245
  • 7 Fountain RB, Holmes DR, Chandrasekaran K, Packer D, Asirvatham S, Van Tassel R et al. The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic PROTECTion in Patients with Atrial Fibrillation) trial. Am Heart J. 2006;151(5):956-61. doi:10.1016/j.ahj.2006.02.005
  • 8 Horstmann S, Zugck C, Krumsdorf U, Rizos T, Rauch G, Geis N, et al. Left atrial appendage occlusion in atrial fibrillation after intracranial hemorrhage. Neurology. 2014;82(2):135-8. doi:10.1212/WNL.20150210201502100022
  • 9 Boriani G, Botto GL, Padeletti L, Santini M, Capucci A, Gulizia M et al. Improving stroke risk stratification using the CHADS2 and CHA2DS2-VASc risk scores in patients with paroxysmal atrial fibrillation by continuous arrhythmia burden monitoring. Stroke. 2011;42(6):1768-70. doi:10.1161/STROKEAHA.110.609297
  • 10 Lip GY, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol. 2011;57(2):173-80. doi:10.1016/j.jacc.2010.09.024
  • 11 Holmes DR, Jr., Kar S, Price MJ, Whisenant B, Sievert H, Doshi SK et al. Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014;64(1):1-12. doi:10.1016/j.jacc.2014.04.029
  • 12 Reddy VY, Möbius-Winkler S, Miller MA, Neuzil P, Schuler G, Wiebe J et al. Left atrial appendage closure with the Watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology). J Am Coll Cardiol. 2013;61(25):2551-6. doi:10.1016/j.jacc.2013.03.035
  • 13 Helsen F, Nuyens D, De Meester P, Rega F, Budts W. Left atrial appendage occlusion: single center experience with PLAATO LAA Occlusion System® and AMPLATZERTM Cardiac Plug. J Cardiol. 2013;62(1):44-9. doi:10.1016/j.jjcc.2013.02.01
  • 14 AMPLATZER cardiac plug clinical trial. Available at: http://clinicaltrials.gov/ct2/show/record/NCT01118299?term=LAAþACP&rank=3.