Review article

When Anticoagulant Therapy is Not an Option

Darija Baković Kramarić

Abstract

Patients with atrial fibrillation who, despite taking oral anticoagulant therapy (OAT), experience a stroke or systemic embolism (SSE) or develop left atrial thrombus (LAAT) should be considered patients with malignant LAA. Administering a different direct oral anticoagulant (DOAC) is the recommended initial step in malignant LAA treatment, followed by switching to a vitamin K antagonist (VKA), low-molecular-weight heparin, or optimized DOAC dosing, while LAA closure is the final option. Left atrial closure is a worthwhile option in patients with embolic stroke even with OAT and no indication of thrombus on TEE (transesophageal echocardiography) (empty LAA) after thorough diagnostic measures to eliminate other sources of embolism, as well as patients with a high risk of hemorrhage.

Keywords

left atrial thrombosis; left atrial occluder; malignant left atrial; stroke

Hrčak ID:

321776

URI

https://hrcak.srce.hr/321776

Publication date:

24.10.2024.

Article data in other languages: croatian

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