Left Atrial Appendage Closure vs Direct Anticoagulants at Long Term

The PRAGUE-17 has shown that left atrial appendage closure is not inferior to direct anticoagulants at long term to prevent major cardiovascular, neurological, or bleeding events. Moreover, procedures not related to prosthesis implantation saw significant reduction.

Cierre de orejuela vs anticoagulantes directos a largo plazo

The PRAGUE-17 was a randomized non-inferiority study comparing left atrial appendage closure (Watchman or Amulet) with direct anticoagulants (95% received apixaban) in patients with non-valvular atrial fibrillation in addition to a history of cardio-embolism, clinically relevant bleeding or both (CHA2DS2-VASc ≥3). 

Primary end point was a combination of cardioembolic events (stroke, transient ischemic attack, or systemic thromboembolism), cardiovascular death, clinically relevant bleeding, or procedure related complications (only for atrial appendage closure).

It included 201 patients in each group (mean age 73.3 ± 7.0). After 3.5 year mean follow-up, atrial appendage closure resulted non inferior to direct anticoagulants for primary end point. 


Read also: PRAGUE-17: Appendage Closure vs. Direct Anticoagulant Agents.


Primary end point resulted similar for both for treatment intention and protocol analysis. 

Conclusion

At long term followup, left atrial appendage closure resulted non inferior to direct anticoagulants in the prevention of cardiovascular, neurological, and bleeding events. After device implantation, bleeding saw significant reduction with these devices.

Original Title: 4-Year Outcomes After Left Atrial Appendage Closure Versus Nonwarfarin Oral Anticoagulation for Atrial Fibrillation.

Reference: Pavel Osmancik et al. J Am Coll Cardiol. 2022 Jan 4;79(1):1-14. doi: 10.1016/j.jacc.2021.10.023.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

AHA 2024 | VANISH2 Trial

Cardiac defibrillator implants (CDIs) have been shown to improve survival in patients with ischemic cardiomyopathy and ventricular tachycardia (VT). However, approximately one third of...

AHA 2024 | SUMMIT

It has been previously shown that the pharmacological treatment of obesity (semaglutide) can reduce cardiovascular events in patients with cardiac failure (CF) and preserved...

OPTION Trial: Left Atrial Appendage Closure

Atrial fibrillation ablation is a valid strategy. However, reoccurrence is frequent in these cases, often with asymptomatic presentation. Anticoagulation with warfarin has proven effective in...

TRI-SPA Study: Tricuspid Edge-to-Edge Treatment

Tricuspid regurgitation (TR) is a condition associated with high morbidity and mortality. Currently, surgery is the recommended treatment; however, it carries a high complication...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

AHA 2024 | VANISH2 Trial

Cardiac defibrillator implants (CDIs) have been shown to improve survival in patients with ischemic cardiomyopathy and ventricular tachycardia (VT). However, approximately one third of...

AHA 2024 | SUMMIT

It has been previously shown that the pharmacological treatment of obesity (semaglutide) can reduce cardiovascular events in patients with cardiac failure (CF) and preserved...

AHA 2024 – BPROAD

Hypertension (elevated blood pressure, BP) is the most common comorbidity among diabetic patients and has been associated with higher cardiovascular risk, though as a...