What are alternatives to long-term anticoagulation for stroke prevention?

Updated: Dec 18, 2018
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

Pharmacologic or nonpharmacologic restoration and maintenance of sinus rhythm renders anticoagulation unnecessary. Patients with atrial fibrillation should receive oral anticoagulation 3 weeks prior to electrical or chemical conversion and at least 4 weeks thereafter. However, if the duration of atrial fibrillation has been less than 48 hours or intracardial thrombus has been excluded on echocardiography, conversion can be performed immediately after placing the patient on IV heparin.

Left atrial appendage is the source of embolization in 90% of patients with atrial fibrillation. On this basis, closure of the left atrial appendage (LAA) intuitively makes sense as an alternative to anticoagulation for decreasing the risk of embolization or stroke. Closure of the LAA proved non inferior to warfarin therapy for preventing embolization among patients with atrial fibrillation in the PROTECT trial (percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomized non inferiority trial). [40]


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