Allied Health Services

Left Atrial Appendage Closure: Mechanical Approaches to by Jacqueline Saw, Saibal Kar, Matthew J. Price

By Jacqueline Saw, Saibal Kar, Matthew J. Price

Percutaneous left atrial appendage (LAA) closure is an rising expertise for thromboembolic prevention in sufferers with atrial traumatic inflammation (AF). the 1st human implantation of an LAA equipment happened in 2001, and because then 4 units have obtained CE mark approval. those units are being ordinary in Europe for LAA closure in sufferers who're bad applicants for long term oral anticoagulation. within the US, the WATCHMAN equipment (Boston clinical) is expected to obtain FDA approval imminently for AF sufferers who're warfarin-eligible. This approval is projected to seriously extend the symptoms for LAA closures all over the world. hence, the amount of systems is predicted to improve. This publication discusses the epidemiology of AF as a reason for stroke; using LAA closure cut back thromboembolism with AF; early surgical ways and novel surgical units for LAA closure; and present percutaneous methods and units to be had for LAA closure. The emphasis of this publication is on percutaneous technical techniques and modern trial effects at the major units (PLAATO, WATCHMAN, Amplatzer Cardiac Plug, and LARIAT). It additionally studies unapproved units in improvement, in either medical and pre-clinical phases.

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Extra resources for Left Atrial Appendage Closure: Mechanical Approaches to Stroke Prevention in Atrial Fibrillation

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2012;141:e576S–600. 51. Vandvik PO, Lincoff AM, Gore JM, et al. Primary and secondary prevention of cardiovascular disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American Collage of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:e637S–68. 52. Cairns JA. Which oral anticoagulant for which atrial fibrillation patient: recent clinical trials and evidence-based choices. Can J Cardiol. 2013;29(10):1165–72. 53. Lip GYH, Larsen TB, Skjoth F, Rasmussen LH.

For the outcome of death, the NNT for dabigatran 150 mg was 169 and for apixaban it was 238. The rates of major extra cranial bleeding were significantly lower with dabigatran 110 mg (NNT = 154), apixaban (NNT = 104) and edoxaban (NNT = 43 for 30 mg and NNT = 147 for 60 mg) but not with dabigatran 150 mg bid 2 Efficacy and Limitations of Warfarin and Novel Oral Anticoagulants with Atrial… 27 or rivaroxaban. 39 %/year (NNT = 227). Even though any incremental therapeutic efficacy and safety of the NOACs over warfarin is rather modest, these advantages definitely enhance patient and particularly physician preferences for the NOACs.

The anticoagulant effects of the VKAs may be reversed by the administration of oral or intravenous preparations of vitamin K, and by the administration of preformed coagulation proteins in fresh frozen plasma or as three- or four factor prothrombin complex concentrates or recombinant activated factor VII [17]. No such direct reversal agents are yet available for the NOACs. Guidelines for management of major bleeding are focused on graded responses depending upon the severity of the bleeding (mild, moderate, life-threatening) and suggest that prothrombin complex concentrates or recombinant activated factor VII be considered in severe bleeding.

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