Decision model favors left atrial appendage occlusion for stroke prevention in patients at highest risk for bleeding

cardiology
Credit: George Hodan/public domain

A decision model found that the relative clinical benefit of left atrial appendage occlusion (LAAO) and oral anticoagulants (OAC) in patients with atrial fibrillation depends on the patients' baseline risks for stroke and bleeding. LAAOs were found to be the preferred strategy in those with the highest bleeding risk. This benefit became less certain with increasing risk for ischemic stroke and decreasing bleeding risk. The findings are published in Annals of Internal Medicine.

LAAO is a potential alternative to OAC in selected patients with . Compared with anticoagulants, LAAO decreases major bleeding risk, but concerns remain over the possible increased risk of .

Researchers from the Libin Cardiovascular Institute, University of Calgary and the Duke Clinical Research Institute, Duke University used a decision-analytic model to simulate a virtual clinical trial of strategies in a cohort of elderly individuals with AF and without prior stroke to better understand the risk–benefit tradeoffs when choosing between LAAO and OACs contingent on a patient's stroke risk and bleeding risk.

The primary end point was clinical benefit measured in quality adjusted life-years, and the secondary end points were or life-years and net clinical benefit. The researchers found that the clinical benefit of LAAO over OACs depends on the patient-specific baseline risk for stroke and bleeding. Although LAAOs were favorable among patients with the highest bleeding risk, that benefit became less certain at higher stroke risk. According to the researchers, these findings may help to inform shared decision making when selecting patients for LAAO.


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More information: Derek S. Chew et al, Left Atrial Appendage Occlusion Versus Oral Anticoagulation in Atrial Fibrillation, Annals of Internal Medicine (2022). DOI: 10.7326/M21-4653

Bharat K. Kantharia, Left Atrial Appendage Occlusion Versus Anticoagulation in Atrial Fibrillation: Equipoise When Bleeding Risk Is High, Annals of Internal Medicine (2022). DOI: 10.7326/M22-2271

Summary for Patients: Occlusion Devices Versus Blood Thinners for Atrial Fibrillation, Annals of Internal Medicine (2022). DOI: 10.7326/P22-0015

Journal information: Annals of Internal Medicine

Citation: Decision model favors left atrial appendage occlusion for stroke prevention in patients at highest risk for bleeding (2022, August 16) retrieved 24 September 2022 from https://medicalxpress.com/news/2022-08-decision-favors-left-atrial-appendage.html
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