NON-PHARMACOLOGICAL METHODS IN STROKE MANAGEMENT IN PATIENTS WITH ATRIAL FIBRILLATION: FROM INTERVENTIONAL METHODS TO SURGERY

Highlights

• Prevention of ischaemic stroke development in atrial fibrillation is an important public health concern. Pharmacological strategies for the prevention of thromboembolic events have a number of limitations and contraindications. Therefore, invasive methods aimed at isolation of the auricle of the left atrium as the main source of thrombosis in patients with non-valvular atrial fibrillation began to be developed. The aim of our review was to provide comprehensive information on the efficacy and safety of interventional and surgical approaches to left atrial auricle isolation. Since 2010, new direct oral anticoagulants (NOACs) have become the leading pharmacotherapy for stroke prevention in patients with AF.

Abstract

Atrial fibrillation (AF) is associated with a high risk of systemic thromboembolic (TE) events. Prevention of ischaemic stroke development in AF is an important task and depends on primary screening, adequate and timely assessment of the patient's risk of stroke development. Medium-term adherence to NOAC medication remains very low, with only 60% continuing anticoagulants 1.3 years after AF diagnosis. In addition, there are patients who continue to have a high incidence of TE events despite regular administration of NOACs. These results, together with the information that in isolated AF, approximately 90% of thrombi are localised in the left atrial appendage (LAA), have prompted the development, testing and subsequent clinical implementation of invasive strategies to isolate the LAA from the systemic blood flow. Thus, among the methods of isolation of LAA are (1) open surgical; (2) endovascular; and (3) minimally invasive video-assisted. The main purpose of this literature review is to present the latest evidence on the efficacy and safety of the main strategies for the prevention of thromboembolic events in patients with AF.

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