Uso de anticoagulantes orales directos en pacientes con fibrilación auricular post implante de TAVI: resultados de una encuesta internacional / Use of anticoagulants in patients with atrial fibrillation undergoing transcatheter aortic valve implantation

BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) is beneficial in patients with symptomatic severe Aortic Stenosis (AS). There is no consensus about the best anticoagulation strategy for patients with a recent TAVI and with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) are effective to prevent embolic events with a significant lower incidence of bleeding. There is scarce evidence about the use of these drugs in patients undergoing TAVI. AIM: To assess the management of anticoagulation at the moment of discharge of patients with AF and TAVI. Material and Methods: A four question survey was sent to cardiologists involved in TAVI programs in different international centers. Results: The survey was answered by 72 interventional cardiologists. Even with the lack of randomized evidence, in most of the scenarios DOACs are prescribed at discharge in patients with indication for anticoagulation. Also, in patients with high bleeding risk, most cardiologists would perform a left atrial appendage closure. In patients with concomitant coronary artery disease, if a stent was recently implanted, prescription of the combination of a DOAC and one antiplatelet drug was the most common answer. In patients with a former coronary angioplasty, DOAC or Warfarin was the therapy of choice. CONCLUSIONS: In the absence of randomized data, interventional cardiologists prescribe DOACs at discharge to patients with AF and TAVI, without following current guidelines in most cases.

Cierre percutáneo de orejuela izquierda con dispositivo LAmbre / Percutaneous closure of the left atrial appendage using the LAmbre device

Abstract Atrial fibrillation (AF) is an increasing health care problem associated with thromboembolic risk about 5% per year, with high mortality and morbidity when associated to stroke. Oral anticoagulants (OAC) are the treatment of choice for preventing ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, these drugs are associated with an increased risk of serious complications such an intracranial hemorrhage (ICH). In this context percutaneous closure of the left atrial appendage (LAA) is an effective therapeutic alternative to OACs, with an increasing success rate. Novel devices might allow or facilitate the procedure in some anatomically and technically complicated cases. Two patients with a complex morphology of the LAA, in which the LAmbre (Lifetech Scientific [Shenzhen] Co. Ltd.) device was implanted with good technical and clinical results are presented.