Baseline risks for stroke, bleeding determine whether LAAO is preferred to anticoagulants for a-fib patients with high bleeding risk
MONDAY, Aug. 15, 2022 (HealthDay News) — For selected patients with atrial fibrillation (AF) and higher bleeding risk, left atrial appendage occlusion (LAAO) may be preferred over oral anticoagulation, according to research published online Aug. 16 in the Annals of Internal Medicine.
Derek S. Chew, M.D., from Duke University in Durham, North Carolina, and colleagues examined the optimal strategy for stroke prevention conditional on the risk for ischemic stroke and bleeding among women and men with nonvalvular AF without prior stroke in a decision analysis with a Markov model.
The researchers found that for patients with AF, the baseline risks for stroke and bleeding determined whether LAAO was preferred over anticoagulants. For higher bleeding risk, the combined risks favored LAAO, but at higher stroke risks, that benefit became less certain. For example, LAAO was favored in more than 80 percent of model simulations for CHA2DS2-VASc scores between 2 and 5 at an HAS-BLED score of 5. At lower bleeding risks (HAS-BLED score of 0 to 1), the probability of LAAO benefit in quality-adjusted life-years was limited to patients with lower stroke risks (CHA2DS2-VASc score of 2). The results were consistent in a sensitivity analysis using the ORBIT bleeding score instead of the HAS-BLED score.
“The LAAO strategy was preferred in those with the highest risk for bleeding. However, the benefit became less certain with increasing risk for ischemic stroke and decreasing bleeding risk,” the authors write. “This description of LAAO benefit has the potential to improve shared decision making when selecting patients for LAAO.”
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