{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T16:33:38Z","timestamp":1793982818854,"version":"4.8.0"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T00:00:00Z","timestamp":1706572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The absence of the left atrial appendage is an exceedingly rare structural variant that could have important implications for anticoagulation regimens in patients with atrial fibrillation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We report the case of a 63-year-old Puerto Rican female with a history of hypertension, cerebral artery aneurysms, and type 2 diabetes mellitus who suffered multiple haemorrhagic strokes. The patient had never received anticoagulation therapy. During the indicated stroke work-up, the patient was found to have paroxysmal atrial fibrillation. Given the patients high risk for thromboembolism and contraindications to anticoagulation therapy, the patient was referred for left atrial appendage occlusion. Pre-procedural transoesophageal echocardiography failed to identify the left atrial appendage. Evaluation by way of cardiac computed tomography confirmed absence of the left atrial appendage. Left atrial appendage occlusion could not be carried out. The patient had been deemed being at high risk of bleeding, was not anticoagulated, and was instead closely followed. The patient has not had thrombo-embolic events nor has she experienced a haemorrhagic stroke recurrence at follow-up appointments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>To our knowledge, this is the first such case report that reports left atrial appendage absence in the setting of multiple haemorrhagic strokes. Given the rarity of the condition and lack of available guidelines, the most viable way to currently manage this patient population is on a case-to-case basis. However, we propose that absence of the left atrial appendage could confer a decreased risk of thrombo-embolic phenomena in patients with atrial fibrillation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae063","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T17:58:35Z","timestamp":1706637515000},"source":"Crossref","is-referenced-by-count":1,"title":["Weighing the risks and benefits of anticoagulation in atrial fibrillation: a case report of left atrial appendage absence in a patient referred for procedural occlusion"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3911-2806","authenticated-orcid":false,"given":"Roberto","family":"Lapetina Arroyo","sequence":"first","affiliation":[{"name":"Department of Medicine, Cardiovascular Disease Division, University of Puerto Rico School of Medicine , P.\u00ba Dr. Jos\u00e9 Celso Barbosa, 00921 San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian Monge","family":"Barrios","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Disease Division, University of Puerto Rico School of Medicine , P.\u00ba Dr. Jos\u00e9 Celso Barbosa, 00921 San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilton Franqui","family":"Rivera","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Disease Division, University of Puerto Rico School of Medicine , P.\u00ba Dr. Jos\u00e9 Celso Barbosa, 00921 San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Orraca","family":"Gotay","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Disease Division, Pavia Santurce Hospital , San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Marrero Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Disease Division, Pavia Santurce Hospital , San Juan , Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,30]]},"reference":[{"key":"2024022909585516800_ytae063-B1","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.case.2023.01.003","article-title":"Congenital absence of the left atrial appendage: role of multimodality imaging","volume":"7","author":"Arguelles","year":"2023","journal-title":"CASE"},{"key":"2024022909585516800_ytae063-B2","doi-asserted-by":"crossref","first-page":"1219021","DOI":"10.3389\/fcvm.2023.1219021","article-title":"Elevated atrial blood stasis in paroxysmal atrial fibrillation during sinus rhythm: a patient-specific computational fluid dynamics study","volume":"10","author":"B\u00e4ck","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"2024022909585516800_ytae063-B3","doi-asserted-by":"crossref","first-page":"S418","DOI":"10.1016\/j.hrthm.2022.03.994","article-title":"PO-696-03 index atrial myopathy correlates with atrial fibrillation burden post ablation independent from ablation-induced scar","volume":"19","author":"Mekhael","year":"2022","journal-title":"Heart Rhythm"},{"key":"2024022909585516800_ytae063-B4","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.jacbts.2019.05.005","article-title":"Atrial myopathy","volume":"4","author":"Shen","year":"2019","journal-title":"JACC Basic Transl Sci"},{"key":"2024022909585516800_ytae063-B5","article-title":"Increased blood stasis in the LV of patients with atrial fibrillation","volume":"134","author":"Real-Vald\u00e9s","year":"2018","journal-title":"Circulation"},{"key":"2024022909585516800_ytae063-B6","first-page":"199","article-title":"Left atrial appendage closure for thromboembolism prevention in patients with atrial fibrillation: advances and perspectives","volume":"7","author":"Kong","year":"2015","journal-title":"J Thorac Dis"},{"key":"2024022909585516800_ytae063-B7","doi-asserted-by":"crossref","first-page":"2878","DOI":"10.1016\/j.jacc.2019.09.064","article-title":"Long-term safety and efficacy in continued access left atrial appendage closure registries","volume":"74","author":"Holmes","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2024022909585516800_ytae063-B8","first-page":"89","article-title":"Long-term effect of anticoagulation following left atrial appendage occlusion with the LARIAT device in patients with nonvalvular atrial fibrillation: impact on thromboembolism, bleeding and mortality. 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