Herz
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Stroke prevention in patients with atrial fibrillation is one of the greatest challenges in modern cardiology. Interventional left atrial appendage occlusion is an alternative to oral anticoagulation in patients with non-valvular atrial fibrillation. This procedure is currently used mainly for patients with elevated risk for bleeding complications (HAS-BLED score ≥3) or other contraindications for oral anticoagulation. ⋯ Both devices necessitate anticoagulation during the first 3-6 months after implantation until endothelialization is completed. Due to the anatomical complexity the implantation should be performed in experienced centers with reduction of the periprocedural risk to <1%. Thus, interventional left atrial appendage occlusion is a valid option to prevent stroke or other thromboembolic events in non-valvular atrial fibrillation especially for elderly patients or those with a history of bleeding complications.
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Atrial fibrillation is the most common form of cardiac arrhythmia with an age-dependent increase in prevalence. It is common clinical practice to treat patients with atrial fibrillation and who have a high risk for thromboembolic stroke with vitamin K antagonists. ⋯ The new oral anticoagulants, e.g. dabigatran as a direct thrombin antagonist or rivaroxaban and apixaban as factor Xa antagonists were tested in large scale clinical trials with respect to the efficacy in stroke prevention in atrial fibrillation patients. The therapeutic superiority over warfarin could be impressively proven either with respect to the efficacy in stroke prevention and/or to the safety of therapy with a significant decrease in cerebral bleeding complications.