{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:29:32Z","timestamp":1790116172874,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,1,28]],"date-time":"2019-01-28T00:00:00Z","timestamp":1548633600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>There are no recommendations regarding how to treat cardioembolic recurrent strokes when patients are well anticoagulated. We evaluated the safety and efficacy of combining oral anticoagulation (<jats:styled-content style=\"fixed-case\">OAC<\/jats:styled-content>) with percutaneous left atrial appendage closure (<jats:styled-content style=\"fixed-case\">LAAC<\/jats:styled-content>) in patients with well\u2010anticoagulated atrial fibrillation (<jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>) with recurrent strokes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In an explorative, prospective, observational study, <jats:styled-content style=\"fixed-case\">LAAC<\/jats:styled-content> was performed in patients with <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content> with at least two ischaemic strokes in the previous year, despite good anticoagulation using the Amplatzer Cardiac Plug (St Jude Medical, St Paul, MN, USA) or Amulet Abbot device (Abbot Vascular, Santa Clara, CA, USA). We recorded age, type of <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> CHA<\/jats:styled-content><jats:sub>2<\/jats:sub><jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content><jats:sub>2<\/jats:sub>\u2010<jats:styled-content style=\"fixed-case\">VASC<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">HAS\u2010BLED<\/jats:styled-content> scores, types of <jats:styled-content style=\"fixed-case\">OAC<\/jats:styled-content> and risk factors. After closure, treatment with aspirin (100\u00a0mg\/day) was continued for 3\u00a0months in combination with indefinite <jats:styled-content style=\"fixed-case\">OAC<\/jats:styled-content>. Clinical status, recurrent embolisms and bleeding complications were recorded during follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 19 patients were included (mean age, 72.1\u00a0\u00b1\u00a09.6\u00a0years; mean <jats:styled-content style=\"fixed-case\">CHA<\/jats:styled-content><jats:sub>2<\/jats:sub><jats:styled-content style=\"fixed-case\">DS<\/jats:styled-content><jats:sub>2<\/jats:sub>\u2010VASC score, 5.3\u00a0\u00b1\u00a01.48; mean number of previous strokes, 2.78\u00a0\u00b1\u00a01.15). Thirteen had spontaneous echocardiographic contrast and all had dilatation of the left atrium. Eighteen patients had a multilobulated left atrial appendage, 17 with \u2018chicken\u2010wing\u2019 morphology and one patient had a left atrial appendage thrombus. There were no complications during the procedure. Only one patient had a transient ischaemic attack and no major bleeding occurred during a mean follow\u2010up of 17.4\u00a0\u00b1\u00a011.5\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Combination therapy with indefinite <jats:styled-content style=\"fixed-case\">OAC<\/jats:styled-content> plus <jats:styled-content style=\"fixed-case\">LAAC<\/jats:styled-content> in patients with <jats:styled-content style=\"fixed-case\">AF<\/jats:styled-content> with recurrent strokes despite good anticoagulation should be considered in order to prevent a new stroke.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13894","type":"journal-article","created":{"date-parts":[[2018,12,26]],"date-time":"2018-12-26T14:30:11Z","timestamp":1545834611000},"page":"816-820","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Oral anticoagulation and left atrial appendage closure: a new strategy for recurrent cardioembolic stroke"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1329-0943","authenticated-orcid":false,"given":"J.","family":"Masjuan","sequence":"first","affiliation":[{"name":"Neurology Department Hospital Universitario Ram\u00f3n y Cajal Madrid"},{"name":"Departamento de Medicina Facultad de Medicina Universidad de Alcal\u00e1 (IRYCIS) Madrid"},{"name":"Invictus Plus Red Nacional de Investigaci\u00f3n en Ictus Madrid"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Salido","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Facultad de Medicina Universidad de Alcal\u00e1 (IRYCIS) Madrid"},{"name":"Cardiology Department Hospital Universitario Ram\u00f3n y Cajal Madrid"},{"name":"CIBER CV Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"DeFelipe","sequence":"additional","affiliation":[{"name":"Neurology Department Hospital Universitario Ram\u00f3n y Cajal Madrid"},{"name":"Departamento de Medicina Facultad de Medicina Universidad de Alcal\u00e1 (IRYCIS) Madrid"},{"name":"Invictus Plus Red Nacional de Investigaci\u00f3n en Ictus Madrid"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Hern\u00e1ndez\u2010Antol\u00edn","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Facultad de Medicina Universidad de Alcal\u00e1 (IRYCIS) Madrid"},{"name":"Cardiology Department Hospital Universitario Ram\u00f3n y Cajal Madrid"},{"name":"CIBER CV Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Fern\u00e1ndez\u2010Golf\u00edn","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Facultad de Medicina Universidad de Alcal\u00e1 (IRYCIS) Madrid"},{"name":"Cardiology Department Hospital Universitario Ram\u00f3n y Cajal Madrid"},{"name":"CIBER CV Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Cruz\u2010Culebras","sequence":"additional","affiliation":[{"name":"Neurology Department Hospital Universitario Ram\u00f3n y Cajal Madrid"},{"name":"Departamento de Medicina Facultad de Medicina Universidad de Alcal\u00e1 (IRYCIS) Madrid"},{"name":"Invictus Plus Red Nacional de Investigaci\u00f3n en Ictus Madrid"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Matute","sequence":"additional","affiliation":[{"name":"Neurology Department Hospital Universitario Ram\u00f3n y Cajal Madrid"},{"name":"Departamento de Medicina Facultad de Medicina Universidad de Alcal\u00e1 (IRYCIS) Madrid"},{"name":"Invictus Plus Red Nacional de Investigaci\u00f3n en Ictus Madrid"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Vera","sequence":"additional","affiliation":[{"name":"Neurology Department Hospital Universitario Ram\u00f3n y Cajal Madrid"},{"name":"Departamento de Medicina Facultad de Medicina Universidad de Alcal\u00e1 (IRYCIS) Madrid"},{"name":"Invictus Plus Red Nacional de Investigaci\u00f3n en Ictus Madrid"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"P\u00e9rez\u2010Torre","sequence":"additional","affiliation":[{"name":"Neurology Department Hospital Universitario Ram\u00f3n y Cajal Madrid"},{"name":"Departamento de Medicina Facultad de Medicina Universidad de Alcal\u00e1 (IRYCIS) Madrid"},{"name":"Invictus Plus Red Nacional de Investigaci\u00f3n en Ictus Madrid"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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