The efficacy and safety of Left atrial appendage closure in patients with AIS-despite-OAC
| Author, year | Study design | No. of patients | Inclusion criteria | Age (years) | CHA2DS2-VASc | HAS-BLED | Follow-up (years) | OAC discontinuation | AIS during follow-up (events/100 patient-years) | Antithrombotic therapy at time of incident AIS | Major bleeding incl. ICH during follow-up (events/100 patient-years) |
| (Current study) | Retrospective observational | 29 (5 VKA, 21 DOAC, 3 both DOAC and VKA) | NVAF patients with previous stroke despite adequate OAC use | 73.4±8.7 | 6.0±1.3 | 4.2±0.9 | 1.75±1.00 | 19 (65.5%) | 1 (1.97%) | DOAC | 1 (1.97%) |
| Cruz-González et al,28 2020 | Retrospective observational | 115 (mostly VKA) | NVAF patients with previous stroke on OAC | 73.8±10.2 | 5.5±1.5 | 3.9±1.3 | 1.35±1.02 | Individualised depending on the patient history, indication for LAAC and physician preference | 3 (1.93%) | Unknown | 0 (0%) |
| Galloo et al29 2020 | Retrospective observational | 15 (40% DOAC, 60% VKA) | NVAF patients with previous stroke on OAC after excluding alternative causes of stroke | 78.1±5.8 | 6±1.2 | 5.0±1.2 | 3.1±2.7 | 4 (26.7%) | 2 (4.30%) | 1 VKA, 1 on no OAC | 0 (0%) |
| Freixa et al30 2019 | Retrospective observational | 22 (13 VKA, 6 DOAC, 3 OAC+ASA) | AF patients with cardioembolic events despite optimal OAC | 68.9±9.1 | 4.5±1.3 | 2.6±1.1 | 1.8 (0.7–2.8) | 3 (13.6%) | 1 (2.52%) | Antiplatelet | 1 (2.52%) haematuria |
| Masjuan et al31 2019 | Prospective observational | 19 (9 VKA, 10 DOAC) | AF patients with a history of at least two recurrent cardioembolic strokes in the previous year despite adequate OAC and after excluding alternative causes of stroke | 72.1±9.6 | 5.3±1.5 | 1.7±1.2 | 1.45±0.96 | 0 | 0 | – | 0 (0%) |
| Pracoń et al32 2022 | Prospective registry | 39 (18 DOAC, 18 VKA, 3 both DOAC and VKA) | NVAF who had AIS/TIA/peripheral embolism/LAA thrombus while on OAC | 73 (62–77) | 5.0 (3.0–6.0) | 2.0 (1.0–3.0) | 1.02 (0.98–1.07) | All discharged on DAPT after LAAC | 3 (7.54%) | Antiplatelet | 0 (0%) |
Variables are expressed as mean ±SD or median (IQR).
AIS, acute ischaemic stroke; DOAC, direct oral anticoagulant; ICH, intracranial haemorrhage; LAA, left atrial appendage; NVAF, non-valvular atrial fibrillation; OAC, oral anticoagulant; TIA, transient ischaemic attack; VKA, vitamin-K anticoagulant.