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Holmes, D.R., Reddy, V.Y., Turi, Z.G., et al. (2009) Percutaneous Closure of the Left Atrial Appendage versus Warfarin Therapy for Prevention of Stroke in Patients with Atrial Fibrillation: A Randomised Non-Inferiority Trial. The Lancet, 374, 534-542.
https://doi.org/10.1016/S0140-6736(09)61343-X

has been cited by the following article:

• TITLE: Is Anticoagulation Warranted after Left Atrial Appendage Ligation in Patients at Risk for Stroke after Cardiac Surgery?

  AUTHORS: Alexander P. Kossar, Yaagnik D. Kosuri, Samantha Nemeth, Brigitte E. Kazzi, Yuming Ning, James Doolittle, Denise McLaughlin, Paul Kurlansky, Isaac George

  KEYWORDS: Arrhythmias, Minimally Invasive Surgery, Perioperative Care

  JOURNAL NAME: World Journal of Cardiovascular Surgery, Vol.13 No.2, February 28, 2023

  ABSTRACT: Objectives: Left atrial appendage ligation (LAAL) may constitute alternative stroke prophylaxis in patients with atrial fibrillation (AF). Herein we describe the 30-day post discharge outcomes of cardiac surgery patients with elevated stroke risk with or without anticoagulation (AC) following epicardial LAAL. Methods: Data were reviewed for 479 consecutive adult patients who underwent epicardial LAAL from 2014-2019 (median CHA2DS2-VASc score = 4.0). There were 251 and 228 patients discharged with and without AC, respectively, who were followed for 30 days. Patients were matched via 1:1 Propensity Score Matching (PSM; n = 115 per group). Post-discharge outcomes included stroke, bleeding, readmission for cardiac re-intervention, mortality, and a composite endpoint comprised of the aforementioned outcomes. Results: There was no difference in post-discharge stroke incidence regardless of AC (adjusted cumulative incidence (ACI) 0.009 CI [0.001 - 0.043] with AC vs 0.009 CI [0.001 - 0.43] without AC; p = 0.826), post-discharge bleeding (ACI 0.018 CI [0.003 - 0.057] with AC vs 0.009 CI [0.001 - 0.046] without AC; p = 0.738), readmission for cardiac re-intervention (ACI 0.009 CI [0.009 - 0.009] with AC vs 0 CI [NA] without AC; p = 0.340, post-discharge mortality (ACI 0 CI NA with AC vs 0.009 CI [0.001 - 0.046] without AC; p = 0.123, or in the composite outcome (ACI 0.026 CI [0.007 - 0.069] with AC vs 0.027 CI [0.007 - 0.071] without AC; p = 0.824. Conclusion: Cessation of AC in patients with elevated stroke risk following epicardial LAAL during cardiac surgery does not affect stroke rate, mortality, or bleeding incidence up to 30 days post-discharge in this preliminary analysis.