Breaking News
April 20, 2018 - FDA Alert: NxtGen Botanicals Maeng Da Kratom by NGB Corp.: Recall
April 20, 2018 - Pelizaeus-Merzbacher-like disease type 1 – Genetics Home Reference
April 20, 2018 - Tick-borne diseases reach epidemic levels, panel says
April 20, 2018 - A potential “male pill” without side effects
April 20, 2018 - Researchers discover new information related to rare form of leukemia
April 20, 2018 - Researchers find crucial links between dopamine and avoidance behavior
April 20, 2018 - UGA scientist creates system for efficient detection of foodborne pathogens
April 20, 2018 - Social Support of Autonomy Tied to Better Glycemic Control in DM
April 20, 2018 - Study reports use of nutritional ketosis with mobile app intervention could reverse Type 2 diabetes
April 20, 2018 - New microscopy techniques allow quasi-biochemical studies on living T cells
April 20, 2018 - Study shows connection between muscular strength and brain health
April 20, 2018 - Ecolab introduces Life Sciences cleanroom program in North America
April 20, 2018 - Male fruit flies like sex and alcohol
April 20, 2018 - Improving job prospects unlikely to control opioid epidemic
April 20, 2018 - Skin Sensor Might Someday Track Alcoholics’ Booze Intake
April 20, 2018 - The relevance of GABA for diabetes highlighted in two new studies
April 20, 2018 - Novel method enables fast and noninvasive assessment of tumor status
April 20, 2018 - IU psychologist receives NIH grant to study earliest phases of language learning in children
April 20, 2018 - Walking fast lowers risk of hospitalization in heart patients, shows study
April 20, 2018 - Young victims of cyberbullying twice as likely to attempt suicide and enact suicidal behavior
April 20, 2018 - Role of UBE3A enzyme in Angelman syndrome
April 20, 2018 - NovaDigm Therapeutics initiates NDV-3A Phase 2a study for reduction of S. aureus in military trainees
April 20, 2018 - High-tech microscope reveals how cancer-causing virus anchors itself to human DNA
April 20, 2018 - Experimental compound reduces destructive inflammation to improve stroke outcome
April 20, 2018 - The May issue of Drug Discovery Today is a Special Issue and will be published very soon
April 20, 2018 - Larger families linked to heightened tooth loss risk for moms
April 20, 2018 - Scientists develop tiny fluorescent probe that seeks out GLUT5 and detects cancer cells
April 20, 2018 - The Swedish Childhood Cancer Foundation awards grant to KI researchers
April 20, 2018 - AMSBIO’s MC-Easy minicircle technology allows sustained transgene expression in quiescent cells and tissues
April 20, 2018 - Researchers use optogenetics to treat chronic pain
April 20, 2018 - Discovery of 100 new genes may aid research into pigmentation
April 20, 2018 - AYOXXA introduces new LUNARIS Mouse 12-Plex Th17 Kit for quantitative analysis of Th17 cell biology
April 20, 2018 - Compound derived from immune cells treats psoriasis in mice
April 20, 2018 - GABA-transaminase deficiency – Genetics Home Reference
April 20, 2018 - Key heart risks decline for older Americans
April 20, 2018 - UD professor wins $2.3 million grant from NIH for research on Achilles tendinopathy
April 20, 2018 - Researchers discover unique protein in malaria parasite that could be new drug target
April 20, 2018 - Bio-Techne expands automation capabilities of popular RNAscope ISH technology
April 20, 2018 - Smartphone app effective in promoting proper child car seat practices
April 20, 2018 - Nutraceuticals could play an important role in preventing heart disease
April 20, 2018 - FDA Alert: Certain Kratom-Containing Powder Products by Viable Solutions: Recall -Possible Salmonella Contamination
April 20, 2018 - What is heart failure?
April 20, 2018 - TIP Biosystems introduces handheld UV-Visible spectrophotometer for photometric measurements
April 20, 2018 - Inactivity of astronauts during spaceflights may have more pronounced effect on skeletal muscle than hypoxia
April 20, 2018 - New SIDS Info app seeks to reduce infant sleep-related deaths
April 20, 2018 - Wide-scale distribution of naloxone effectively prevents overdose deaths, study finds
April 20, 2018 - Triple-negative breast cancer found to be chemoresistant prior to treatment
April 20, 2018 - ACL tears occur the same way in women and men, study finds
April 20, 2018 - UT Southwestern researchers identify 170 potential therapeutic targets for lung cancer
April 20, 2018 - Finding the ‘keyhole’ to beat obesity at the cellular level
April 20, 2018 - Long-term exposure to cold temperatures reduces diabetes and obesity, shows study
April 20, 2018 - Metabolic Syndrome Common With Chronic Hep B Infection
April 20, 2018 - Tracking quality of life during prostate cancer treatment
April 20, 2018 - Study shows presence of beta-amyloid dimers in the brains of Alzheimer’s patients
April 20, 2018 - Researchers identify link between physical inactivity and increased risk of dying from cancer
April 20, 2018 - Breathtaking evolution amongst Indonesian tribe
April 20, 2018 - Study shows testosterone deficiency in men is associated with chronic diseases
April 20, 2018 - Simple one-page form helps improve satisfaction of patients with care
April 20, 2018 - Researchers evaluate accuracy of simple blood test to predict lung cancer
April 20, 2018 - Study looks at sperm producing ability in testicular cancer patients
April 20, 2018 - Exercise In, Vitamin D Out for Preventing Falls: U.S. Panel
April 20, 2018 - Skin cancers associated with decreased risk of developing AD
April 20, 2018 - Preserving fertility during chemotherapy
April 20, 2018 - Teva and Procter & Gamble Company terminate PGT Healthcare partnership
April 20, 2018 - People diagnosed with traumatic brain injury may have increased risk of Parkinson’s disease, shows study
April 20, 2018 - Researchers use smartphone to diagnose people infected with Loa loa worm
April 20, 2018 - College students with autism have high rate of suicidal thoughts
April 20, 2018 - Study sheds light on how the HSC niche is maintained
April 20, 2018 - Drug test spurs frank talk between hypertension patients and doctors
April 19, 2018 - Low-cost deworming drug improves female farmers’ physical fitness
April 19, 2018 - Genome editing identifies neural circuit behind leptin’s anti-obesity and anti-diabetes effects
April 19, 2018 - Many European countries lack comprehensive policy to eliminate viral hepatitis
April 19, 2018 - Young people with ADHD ‘more likely’ to come from deprived neighbourhoods
April 19, 2018 - SLU professor discovers new biomarkers for chlorine gas exposure
April 19, 2018 - Study proposes new mechanism that may contribute to gender differences in weight control
April 19, 2018 - Sleep restriction therapy does not interfere with insomnia patient’s driving ability, research shows
April 19, 2018 - Deep brain stimulation offers relief to UTHealth patient with treatment-resistant depression
April 19, 2018 - Study shows fatty fish and camelina oil boost HDL and IDL cholesterol
April 19, 2018 - FDA Alert: Euphoric Capsules by Epic Products: Recall
April 19, 2018 - Researchers identify peptide produced during cartilage deterioration as a potential source of osteoarthritis pain
Thromboembolism Less Likely With LAA Closure Added to Cardiac Surgery

Thromboembolism Less Likely With LAA Closure Added to Cardiac Surgery

image_pdfDownload PDFimage_print

Left atrial appendage (LAA) closure at the time of cardiac surgery was associated with reduced intermediate-term thromboembolic risk for patients with atrial fibrillation (Afib), according to a registry study.

A retrospective analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database showed that out of more than 10,000 patients, 37% got surgical LAA occlusion during cardiac surgery (coronary artery bypass grafting [CABG], mitral valve surgery with or without CABG, or aortic valve surgery with or without CABG).

Readmissions for stroke, transient ischemic attack, or systemic embolism reached a rate of 4.2% among those who got surgical LAA occlusion and 6.2% for those who didn’t (adjusted HR 0.67, 95% CI 0.56-0.81), J. Matthew Brennan, MD, MPH, of Duke University School of Medicine in Durham, N.C., and colleagues reported online in the Journal of the American Medical Association.

“These findings support the use of surgical LAA occlusion, but randomized trials are necessary to provide definitive evidence,” Brennan’s group concluded.

Concomitant surgical LAA occlusion was also favored by the endpoints of of all-cause mortality (17.3% versus 23.9%, adjusted HR 0.88, 95% CI 0.79-0.97) and combined thromboembolism, hemorrhagic stroke, and all-cause mortality (20.5% versus 28.7%, adjusted HR 0.83, 95% CI 0.76-0.91). Hemorrhagic strokes occurred in 0.9% of patients in both groups (adjusted HR 0.84, 95% CI 0.53-1.32).

The study included patients age 65 years and older with Medicare claims data (median age 76 years, 39% women) who had Afib. Participants were followed up to 3 years.

Surgical LAA occlusion was associated with reduced risk of thromboembolism among patients discharged without anticoagulation (4.2% versus 6.0%, adjusted HR 0.26, 95% CI 0.17-0.40), but not those discharged with anticoagulation (4.1% versus 6.3%, adjusted HR 0.88, 95% CI 0.56-1.39).

More of the surgical LAA occlusion group got anticoagulation (68.9% versus 60.3%, P<0.001).

“In the cohort of patients discharged with oral anticoagulation, surgical LAA occlusion was not associated with thromboembolism but was associated with a lower risk for hemorrhagic stroke, presumably related to eventual discontinuation of oral anticoagulation among surgical LAA occlusion patients,” the investigators noted.

An accompanying opinion article by Victor Ferraris, MD, PhD, of the University of Kentucky in Lexington, said there are important clinical implications to the study’s findings.

“A reasonable hypothesis based on the authors’ findings is that ablation procedures that occlude the left atrial appendage are adequate treatments to avoid thromboembolism and to minimize postoperative anticoagulation-related hemorrhage. This somewhat novel hypothesis, if true, could avoid a significant morbidity associated with anticoagulation while providing adequate treatment for thromboembolic complications of Afib,” Ferraris said.

Even so, the true long-term rate of anticoagulation in the study population was unknown, he noted. “The database only allowed recognition of the anticoagulation rate at discharge and did not account for subsequent use of or adherence to anticoagulation later after discharge.”

Other caveats include the limited generalizability of the study to younger individuals and the lack of stratification by surgical technique. The retrospective nature of the study also left room for residual confounding, Brennan and colleagues acknowledged.

“Any future randomized trial would have to measure the effectiveness of left atrial appendage occlusion at various times after operation and this necessity adds to the complexity of any future trial design,” according to Ferraris. “Limited data on the effectiveness of surgical LAA occlusion caused some uncertainty among professional organizations developing practice recommendations, and this uncertainty is reflected in the class IIb recommendation regarding benefit of surgical LAA occlusion for thromboembolism protection in both the U.S. and European guidelines.”

Brennan disclosed an award from the Burroughs Welcome Fund and an FDA grant.

Study co-authors reported several ties to industry.

Ferraris listed no relevant conflicts of interest.

2018-01-23T11:00:00-0500

Tagged with:

About author

Related Articles