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Procedure Offers Alternative to Warfarin for Stroke Risk

Last Updated: August 14, 2009.

Atrial fibrillation patients at risk of stroke may benefit from percutaneous closure of the left atrial appendage as an alternative to long-term warfarin therapy, according to a study in the Aug. 15 issue of The Lancet.

FRIDAY, Aug. 14 (HealthDay News) -- Atrial fibrillation patients at risk of stroke may benefit from percutaneous closure of the left atrial appendage (LAA) as an alternative to long-term warfarin therapy, according to a study in the Aug. 15 issue of The Lancet.

David R. Holmes, M.D., of the Mayo Clinic College of Medicine in Rochester, Minn., and colleagues enrolled 707 patients with non-valvular atrial defibrillation who were 75 years or older or had had a stroke or transient ischemic attack, congestive heart failure, diabetes, or hypertension. The patients were randomized to receive either percutaneous closure of the LAA and cessation of warfarin or usual warfarin treatment. The end point of the study was a composite of stroke, cardiovascular death, and embolism.

At 1,065 patient years of follow-up, the researchers found the efficacy event rate to be 3.0 per 100 patient-years in the study group and 4.9 per 100 patient-years in the control group. The probability of non-inferiority of the LAA closure to the warfarin treatment was calculated to be more than 99.9 percent. Adverse events occurred more frequently in the study than the control group (7.4 per 100 patient-years versus 4.4 per 100 patient-years).

"Although there was a higher rate of adverse safety events in the intervention group than in the control group, events in the intervention group were mainly a result of periprocedural complications. Closure of the LAA might provide an alternative strategy to chronic warfarin therapy for stroke prophylaxis in patients with non-valvular atrial fibrillation," the authors write.

The study was funded by Atritech, maker of the WATCHMAN left atrial appendage device. One study author and the Mayo Clinic reported having a potential interest in Atritech. Another study author reported financial arrangements with a firm that consults with Atritech.

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