Evolution of Stroke Prevention in Nonvalvular Atrial Fibrillation Patients

• Published in: Journal of the American College of Cardiology Vol. 64; no. 1; pp. 13 - 15
• Main Author: Lee, Randall J., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 08.07.2014
• Subjects: Anticoagulants; Anticoagulants - administration & dosage; Atrial Appendage - surgery; Atrial Fibrillation - drug therapy; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiac Surgical Procedures - standards; Cardiology; Cardiovascular; Drug therapy; Female; Heart attacks; Humans; Internal Medicine; Male; Mortality; Older people; Stroke; Warfarin - administration & dosage; atrial fibrillation; stroke prevention; left atrial appendage
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2014.04.030

[...]many patients in PROTECT AF were treated with chronic clopidogrel and/or remained on warfarin >45 days after device implantation. [...]at the request of the FDA, the PREVAIL study was designed to address the limitations of PROTECT AF and to assess the safety and efficacy of LAA occlusion for stroke prevention compared with long-term warfarin therapy in patients with NVAF. In highly skilled centers in which LAA exclusion is routinely performed, the procedural risks in elderly patients do not seem to differ from younger patients (8). [...]additional data become available for these high-risk patients, the decision to treat them with an LAA occlusion device instead of oral anticoagulation therapy should be made on the basis of the patient's overall health, ability to tolerate oral anticoagulation therapy, procedural risks, and the operator's experience.