Left atrial appendage occlusion in patients with atrial fibrillation and high risk of fall: a clinical dilemma or a budgetary issue?
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In patients with atrial fibrillation (AF), the left atrial appendage (LAA) is a known source of thrombi.
Although oral anticoagulation (OAC) remains the first stroke prevention tool in patients with non-valvular AF, percutaneous or minimally invasive surgical LAA-occlusion (LAAO) and exclusion using different devices have been recently proposed as an alternative in patients with contraindications to long-term OAC therapy [1, 2, 3]. In patients under OAC a history of falls does not seem to be associated with a marked increase in the risk of intracranial hemorrhage [4, 5]. For this reason, the European guidelines for AF-management do not advice OAC withholding and LAAO, unless there is evidence of severe uncontrolled falls (e.g. epilepsy or advanced multisystem atrophy with backwards falls), or in selected patients with dementia (lack of adherence) .
We have recently evaluated a 92-year-old gentleman with a history of non-valvular chronic AF, previous bypass surgery, and two...
- 4.Jacobs LG, Billett HH, Freeman K, Dinglas C, Jumaquio L (2009) Anticoagulation for stroke prevention in elderly patients with atrial fibrillation, including those with falls and/or early-stage dementia: a single-center, retrospective, observational study. Am J Geriatr Pharmacother 7:159–166CrossRefGoogle Scholar