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@article{Whitlock:2021:10.1056/NEJMoa2101897,
author = {Whitlock, RP and Belley-Cote, EP and Paparella, D and Healey, JS and Brady, K and Sharma, M and Reents, W and Budera, P and Baddour, AJ and Fila, P and Devereaux, PJ and Bogachev-Prokophiev, A and Boening, A and Teoh, KHT and Tagarakis, GI and Slaughter, MS and Royse, AG and McGuinness, S and Alings, M and Punjabi, PP and Mazer, CD and Folkeringa, RJ and Colli, A and Avezum, A and Nakamya, J and Balasubramanian, K and Vincent, J and Voisine, P and Lamy, A and Yusuf, S and Connolly, SJ},
doi = {10.1056/NEJMoa2101897},
journal = {New England Journal of Medicine},
pages = {1--10},
title = {Left atrial appendage occlusion during cardiac surgery to prevent stroke},
url = {http://dx.doi.org/10.1056/NEJMoa2101897},
volume = {384},
year = {2021}
}

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TY  - JOUR
AB  - BACKGROUNDSurgical occlusion of the left atrial appendage has been hypothesized to prevent ischemic stroke in patients with atrial fibrillation, but this has not been proved. The procedure can be performed during cardiac surgery undertaken for other reasons.METHODSWe conducted a multicenter, randomized trial involving participants with atrial fibrillation and a CHA2DS2-VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating greater risk of stroke) who were scheduled to undergo cardiac surgery for another indication. The participants were randomly assigned to undergo or not undergo occlusion of the left atrial appendage during surgery; all the participants were expected to receive usual care, including oral anticoagulation, during follow-up. The primary outcome was the occurrence of ischemic stroke (including transient ischemic attack with positive neuroimaging) or systemic embolism. The participants, research personnel, and primary care physicians (other than the surgeons) were unaware of the trial-group assignments.RESULTSThe primary analysis population included 2379 participants in the occlusion group and 2391 in the no-occlusion group, with a mean age of 71 years and a mean CHA2DS2-VASc score of 4.2. The participants were followed for a mean of 3.8 years. A total of 92.1% of the participants received the assigned procedure, and at 3 years, 76.8% of the participants continued to receive oral anticoagulation. Stroke or systemic embolism occurred in 114 participants (4.8%) in the occlusion group and in 168 (7.0%) in the no-occlusion group (hazard ratio, 0.67; 95% confidence interval, 0.53 to 0.85; P=0.001). The incidence of perioperative bleeding, heart failure, or death did not differ significantly between the trial groups.CONCLUSIONSAmong participants with atrial fibrillation who had undergone cardiac surgery, most of whom continued to receive ongoing antithrombotic therapy, the risk of ischemic stroke or systemic embolism was lower with co
AU  - Whitlock,RP
AU  - Belley-Cote,EP
AU  - Paparella,D
AU  - Healey,JS
AU  - Brady,K
AU  - Sharma,M
AU  - Reents,W
AU  - Budera,P
AU  - Baddour,AJ
AU  - Fila,P
AU  - Devereaux,PJ
AU  - Bogachev-Prokophiev,A
AU  - Boening,A
AU  - Teoh,KHT
AU  - Tagarakis,GI
AU  - Slaughter,MS
AU  - Royse,AG
AU  - McGuinness,S
AU  - Alings,M
AU  - Punjabi,PP
AU  - Mazer,CD
AU  - Folkeringa,RJ
AU  - Colli,A
AU  - Avezum,A
AU  - Nakamya,J
AU  - Balasubramanian,K
AU  - Vincent,J
AU  - Voisine,P
AU  - Lamy,A
AU  - Yusuf,S
AU  - Connolly,SJ
DO  - 10.1056/NEJMoa2101897
EP  - 10
PY  - 2021///
SN  - 0028-4793
SP  - 1
TI  - Left atrial appendage occlusion during cardiac surgery to prevent stroke
T2  - New England Journal of Medicine
UR  - http://dx.doi.org/10.1056/NEJMoa2101897
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000652582300001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://www.nejm.org/doi/10.1056/NEJMoa2101897
UR  - http://hdl.handle.net/10044/1/89235
VL  - 384
ER  -

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