LAA Closure: Where we stand now?
Abstract
Insiden fibrilasi atrium diperkirakan akan makin meningkat dimasa yang akan datang. Stroke merupakan persoalan besar pada fibrilasi atrium dengan risiko hingga 5 kali lebih besar dibandingkan pasien tanpa fibrilasi atrium. Bahkan risiko stroke tersebut tidak berbeda baik pada fibrilasi atrium yang paroksismal maupun persisten. Terlebih lagi penderita fibrilasi atrium bila mengalami stroke umumnya mempunyai gejala yang lebih berat, disabilitas yang lebih parah serta rekurensi yang lebih sering dibandingkan pasien non fibrilasi atrium.
Oleh karena itu stratifikasi risiko stroke pada pasien fibrilasi atrium menjadi sangat penting untuk pencegahan stroke yang lebih baik dan terarah. Skor CHA2DS2VaSc terbukti efektif sebagai panduan pemilihan pasien fibrilasi atrium yang mendapat terapi antikoagulan. Antikoagulan baik antagonis vitamin K (warfarin) maupun antikoagulan oral baru (direct antithrombin atau anti faktor Xa) secara signifikan dapat menurunkan kejadian stroke dengan komplikasi perdarahan yang kecil.
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References
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Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu
J, Wallentin L. Apixaban versus warfarin in patients with atrial
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Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke
W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker
RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM.
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Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder
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atrial appendage versus warfarin therapy for prevention of stroke
in patients with atrial fibrillation: a randomised non-inferiority
trial. Lancet. 2009;374(9689):534-542.
Reddy VY, Doshi SK, Sievert H, Buchbinder M, Neuzil P, Huber
K, Halperin JL, Holmes D. Percutaneous left atrial appendage
closure for stroke prophylaxis in patients with atrial fibrillation:
2.3-Year Follow-up of the PROTECT AF (Watchman Left Atrial
Appendage System for Embolic Protection in Patients with Atrial
Fibrillation) Trial. Circulation. 2012;127(6):720-729.
WP, Seward JB, Tsang TS. Secular trends in incidence
of atrial fibrillation in Olmsted County, Minnesota, 1980 to
2000, and implications on the projections for future prevalence.
Circulation. 2006;114(2):119-125.
Savelieva I, Bajpai A, Camm AJ. Stroke in atrial fibrillation:
update on pathophysiology, new antithrombotic therapies, and
evolution of procedures and devices. Ann Med. 2007;39(5):371-
391.
Flaker GC, Belew K, Beckman K, Vidaillet H, Kron J, Safford
R, Mickel M, Barrell P. Asymptomatic atrial fibrillation: demographic
features and prognostic information from the Atrial
Fibrillation Follow-up Investigation of Rhythm Management
(AFFIRM) study. Am Heart J. 2005;149(4):657-663.
Hart RG, Pearce LA, Rothbart RM, McAnulty JH, Asinger
RW, Halperin JL. Stroke with intermittent atrial fibrillation:
incidence and predictors during aspirin therapy. Stroke Prevention
in Atrial Fibrillation Investigators. J Am Coll Cardiol.
2000;35(1):183-187.
Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin
EJ, D’Agostino RB. Stroke severity in atrial fibrillation. The
Framingham Study. Stroke. 1996;27(10):1760-1764.
Penado S, Cano M, Acha O, Hernandez JL, Riancho JA. Atrial
fibrillation as a risk factor for stroke recurrence. Am J Med.
2003;114(3):206-210.
Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser
SH, Hindricks G, Kirchhof P. 2012 focused update of
the ESC Guidelines for the management of atrial fibrillation:
an update of the 2010 ESC Guidelines for the management
of atrial fibrillation. Developed with the special contribution
of the European Heart Rhythm Association. Eur Heart J.
2012;33(21):2719-2747.
Morgan CL, McEwan P, Tukiendorf A, Robinson PA, Clemens
A, Plumb JM. Warfarin treatment in patients with atrial fibrillation:
observing outcomes associated with varying levels of INR
control. Thromb Res. 2009;124(1):37-41.
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J,
Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S,
Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener
HC, Joyner CD, Wallentin L. Dabigatran versus warfarin in patients
with atrial fibrillation. N Engl J Med. 2009;361(12):1139-
1151.
Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek
EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A,
Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia
D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo
AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS,
Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu
J, Wallentin L. Apixaban versus warfarin in patients with atrial
fibrillation. N Engl J Med. 2011;365(11):981-992.
Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke
W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker
RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM.
Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N
Engl J Med. 2011;365(10):883-891.
Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder
M, Mullin CM, Sick P. Percutaneous closure of the left
atrial appendage versus warfarin therapy for prevention of stroke
in patients with atrial fibrillation: a randomised non-inferiority
trial. Lancet. 2009;374(9689):534-542.
Reddy VY, Doshi SK, Sievert H, Buchbinder M, Neuzil P, Huber
K, Halperin JL, Holmes D. Percutaneous left atrial appendage
closure for stroke prophylaxis in patients with atrial fibrillation:
2.3-Year Follow-up of the PROTECT AF (Watchman Left Atrial
Appendage System for Embolic Protection in Patients with Atrial
Fibrillation) Trial. Circulation. 2012;127(6):720-729.
Published
2014-03-24
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How to Cite
Yuniadi, Y. (2014). LAA Closure: Where we stand now?. Indonesian Journal of Cardiology, 34(3), 145-6. https://doi.org/10.30701/ijc.v34i3.334
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