Stroke risks of LAA isolation even when in NOAC?

Percutaneous Aspiration of LAA Thrombus
Dr.Rodney Horton discusses technique to treat a large left atrial appendage thrombus. He talks about a patient on NOAC who still got a stroke. Natale had shared it on Twitter. [mobile.twitter.com]


This other article below is 3 years old but mentions 17% still get LAA thrombus while on a NOAC.
[www.healio.com]

I can’t find any current data? Please share if you can. My father had 14 strokes, brother 7. I don’t want their lifestyle. It would make living with AF and flutter preferably better.
Since I fell under the category of a less successful first ablation when 8 months later my AF and now new flutter began, against the arbitrary high hopeful success rate, odds to me are realistic that I maybe prone to be included with family history and bad luck to possibly be one of the 17% who get a stroke after a LAA isolation while on Eliquis.

I had a tumor removed years ago behind my ear inside my head. The risk of side effects of a sunken face was one in many millions. I got that. The odds that my salivary glands once they attached my face back would reroute and excrete saliva in the sunken area between my ear and neck—was also so rare I don’t recall the numbers. I got that too. So even any risk is high with my luck. The surgeon was excellent who removed the tumor so the odds were not based on iatrogenic error.

I can’t find any current peer reports on strokes when on a NOAC after a LAA isolation without a watchman. I’m allergic to nickel.



Edited 2 time(s). Last edit at 08/06/2020 02:31AM by susan.d.

Hi Susan,

The second study above you reference from Hamburg Germany describing a 17% thrombus rate in patients on NOACS that had undergone a very different approach to LAA Isolation. Certainly compared to the more successful and safer 'Ostial LAA Isolation' technique popularized by Dr Natale, in which only the mouth (aka Ostium) of the LAA is encircled by a single lesion.

This, in contrast to the German groups approach in which much more left atrial tissue is included in this more global LAA isolation approach, compared to the more refined and effective Ostial LAA-iso technique.

The German study reported a whopping 18% of their patients having an embolic event post-LAA-Iso using this very different and far more risky approach. This dramatically higher stroke risk reported by the German group compared to competent Ostial LAA isolation as done in the US and much of the rest of the world, was due not only to the much larger area of the left atria required to achieve LAA iso, but also was in part due to a more lax follow up of their study patients to insure they all took NOAC drugs immediately and consistently after LAA isolation.

A good number of those 18% of strokes reported should never have happened had their patients been more rigorously educated to never miss an OAC drug dose or insist on LAA occlusion first all such patients.

In other words, this German study does not reflect at all the efficacy and safety proven with expert application of Ostial LAA Isolation.

It's like comparing apples and oranges.

Cheers,
Shannon



Edited 2 time(s). Last edit at 08/13/2020 09:56AM by Shannon.