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DOAC Therapy in Patients Post Left Atrial Appendage Occlusion or Isolation

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Direct Oral Anticoagulants

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Abstract

Anticoagulation for systemic disease–based risk in patients with atrial fibrillation (AF) remains the cornerstone of stroke prevention therapies. Limitations with contemporary anticoagulation therapies have provided a very attractive substrate for the development of alternative approaches to reduce stroke rates in patients with AF. When an intracardiac source of stroke is identified in patients with atrial fibrillation, the left atrial appendage (LAA) is the most common location. LAA closure systems compared to vitamin K antagonists lower total stroke rates, but do not reduce or may slightly increase risk of embolic strokes. Anticoagulation is critical post implantation to reduce device-related thrombus and in patients with residual leaks. Even after a successful implantation, long-term antiplatelet therapy is needed. The type of antithromboic therapy, duration of therapy, and in what combination to use is not well studied for preferential benefit. The studies that provide some evidence have relied on an endpoint of symptomatic stroke, which is a myopic view of the spectrum of brain injuries in patients with AF, and more research is needed to understand how LAA closure impact long-term risk of these many potential injuries. Finally, there remains a critical need to systematically explore the role of different long-term antithrombotic strategies in patients that receive an LAA closure device.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    T. Jared Bunch

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  1. T. Jared Bunch
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Correspondence to T. Jared Bunch .

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Editors and Affiliations

  1. Cardiac Rehabilitation Unit Ospedale, Sacra Famiglia Fatebenefratelli, Erba, Italy

    Riccardo Proietti

  2. McGill University, Montreal, QC, Canada

    Ahmed AlTurki

  3. Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padova, Italy

    Nicola Ferri

  4. Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli” - Monaldi Hospital, Naples, Italy

    Vincenzo Russo

  5. Division of Cardiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    T. Jared Bunch

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Bunch, T.J. (2021). DOAC Therapy in Patients Post Left Atrial Appendage Occlusion or Isolation. In: Proietti, R., AlTurki, A., Ferri, N., Russo, V., Bunch, T.J. (eds) Direct Oral Anticoagulants. Springer, Cham. https://doi.org/10.1007/978-3-030-74462-5_14

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  • DOI: https://doi.org/10.1007/978-3-030-74462-5_14

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