New technique for stroke patients with a-fib offers warfarin alternative

A study of patients with atrial fibrillation and one or more comorbidities showed that using left atrial appendage closure reduced rates of stroke, cardiovascular death, and systemic embolism more effectively than warfarin therapy.

ATRIAL FIBRILLATION PATIENTS with a stroke risk are often treated with warfarin. A new technique used for left atrial appendage (LAA) closure may be an alternate treatment. Researchers enrolled 707 patients with non-valvular atrial fibrillation, who had at least one of the following criteria: stroke, transient ischemic attack, congestive heart failure, diabetes, hypertension, or age of at least 75 years. The patients were randomized to receive either percutaneous closure of the LAA and warfarin cessation, or usual warfarin treatment, with a target international normalized ratio between 2.0 and 3.0. The end point of the study was a composite of stroke, cardiovascular death, and systemic embolism.

At 1,065 patient-years of follow-up, the combined rate for stroke, cardiovascular death, and systemic embolism was 3.0 per 100 patient-years in the study group and 4.9 per 100 patient-years in the control group. Warfarin therapy was stopped at 45 days in 87% of the patients in the study group.

Holmes DR, Reddy VY, Turi ZG, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet. August 15, 2009;374(9689):534–542.

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