A new study by researchers at the University of Tennessee Health Science Center and the University of Iowa provides good news for patients with atrial fibrillation (AFib), or irregular heartbeat, who are at greater risk for stroke but cannot tolerate long-term anticoagulation therapy, the first-line treatment to prevent stroke. The study determined that an implanted device, known as a left atrial appendage closure (LAAC) device, decreases risk of stroke for those with AFib, compared to the risk associated when anticoagulation therapy is not used.
Rajesh Kabra, MD, FHRS, associate professor of Medicine, Cardiac Electrophysiology, is the lead author of the population-based cohort study of approximately 30,000 Medicare patients who received the device. The study was published in JAMA Network Open. The results found that the Watchman device, the first FDA-approved and most-commonly used LAAC device, provides a satisfactory option for patients unable to take blood thinners.
The umbrella-shaped LAAC device is implanted into the heart to plug the left atrial appendage so that it cannot release clots into the heart. After the implant, patients spend about 45 days on blood thinners and eventually take only aspirin for increased stroke prevention.
“I think it’s very reassuring to those who cannot take long-term blood thinners,” Dr. Kabra said. “Despite these being older patients with a lot of other comorbidities, the device was effective in preventing stroke in that population.”
Atrial fibrillation is the most-common heart rhythm problem in the United States, Dr. Kabra said. It is associated with a five-times higher risk of stroke, especially in patients who are in their 80s. AFib accounts for one-fourth to one-fifth of all strokes.
“AFib currently affects approximately six million Americans,” Dr. Kabra said. “Over the next 10 to 15 years, that number is going to double, because it is seen more in the elderly population.”
He said blood thinners remain the first-line treatment for AFib. However, these devices are indicated in patients who cannot take blood thinners because they have bleeding issues, or are at risk for fall, or have other conditions.
“Our study basically reaffirms that in the real world (as opposed to in a clinical trial), these devices do prevent stroke,” Dr. Kabra said. “Even though the patients were older and were sicker than in the clinical trials, the effectiveness in stroke prevention remained. So, we can be more confident in recommending these devices to our AFib patients who cannot take long-term blood thinners.”