{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:19:13Z","timestamp":1791393553641,"version":"4.3.3"},"reference-count":76,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T00:00:00Z","timestamp":1620000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Atrial fibrillation (AF) is a common cardiac arrhythmia with an estimated prevalence of 1% in the general population. It is associated with an increased risk of ischemic stroke, silent cerebral ischemia, and cognitive impairment. Due to the blood flow stasis and morphology, thrombus formation occurs mainly in the left atrial appendage (LAA), particularly in the setting of nonvalvular AF (NVAF). Previous studies have shown that &gt;90% of emboli related to NVAF originate from the LAA, thus prevention of systemic cardioembolism is indicated. According to the current guidelines, anticoagulant therapy with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs), represents the standard of care in AF patients, in order to prevent ischemic stroke and peripheral embolization. Although these drugs are widely used and DOACs have shown, compared to VKAs, non-inferiority for stroke prevention with significantly fewer bleeding complications, some issues remain a matter of debate, including contraindications, side effects, and adherence. An increasing number of patients, indeed, because of high bleeding risk or after experiencing life-threatening bleedings, must take anticoagulants with extreme caution if not contraindicated. While surgical closure or exclusion of LAA has been historically used in patients with AF with contradictory results, in the recent years, a novel procedure has emerged to prevent the cardioembolic stroke in these patients: The percutaneous left atrial appendage occlusion (LAAO). Different devices have been developed in recent years, though not all of them are approved in Europe and some are still under clinical investigation. Currently available devices have shown a significant decrease in bleeding risk while maintaining efficacy in preventing thromboembolism. The procedure can be performed percutaneously through the femoral vein access, under general anesthesia. A transseptal puncture is required to access left atrium and is guided by transesophageal echocardiography (TEE). Evidence from the current literature indicates that percutaneous LAAO represents a safe alternative for those patients with contraindications for long-term oral anticoagulation. This review summarizes scientific evidences regarding LAAO for stroke prevention including clinical indications and an adequate patient selection.<\/jats:p>","DOI":"10.3390\/medicina57050444","type":"journal-article","created":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T22:51:42Z","timestamp":1620255102000},"page":"444","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Percutaneous Left Atrial Appendage Occlusion: An Emerging Option in Patients with Atrial Fibrillation at High Risk of Bleeding"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3802-7052","authenticated-orcid":false,"given":"Giovanni","family":"Cimmino","sequence":"first","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy"},{"name":"Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco S.","family":"Loffredo","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy"},{"name":"Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy"},{"name":"Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Gallinoro","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy"},{"name":"Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Prozzo","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Fabiani","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy"},{"name":"Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Cante","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy"},{"name":"Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Salerno","sequence":"additional","affiliation":[{"name":"Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Cappelli Bigazzi","sequence":"additional","affiliation":[{"name":"Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Golino","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy"},{"name":"Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Gallinoro, E., D\u2019Elia, S., Prozzo, D., Lioncino, M., Natale, F., Golino, P., and Cimmino, G. (2019). Cognitive Function and Atrial Fibrillation: From the Strength of Relationship to the Dark Side of Prevention. Is There a Contribution from Sinus Rhythm Restoration and Maintenance?. Medicina, 55.","DOI":"10.3390\/medicina55090587"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1161\/CIRCOUTCOMES.113.000127","article-title":"Risks and benefits of anticoagulation in atrial fibrillation: Insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry","volume":"6","author":"Cullen","year":"2013","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_4","first-page":"1129","article-title":"A Review of The Relevant Embryology, Pathohistology, and Anatomy of The Left Atrial Appendage for The Invasive Cardiac Electrophysiologist","volume":"8","author":"DeSimone","year":"2015","journal-title":"J. Atr. Fibrillation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1111\/j.0954-6820.1969.tb07351.x","article-title":"Atrial fibrillation. I. A study of atrial thrombosis and systemic embolism in a necropsy material","volume":"185","author":"Aberg","year":"1969","journal-title":"Acta Med. Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s10840-018-0458-4","article-title":"Left atrial appendage exclusion during mitral valve surgery and stroke in atrial fibrillation","volume":"53","author":"Abrich","year":"2018","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/0003-4975(95)00887-X","article-title":"Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation","volume":"61","author":"Blackshear","year":"1996","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","first-page":"S70","article-title":"Left atrial appendage exclusion\u2014Where do we stand?","volume":"6","author":"Sakellaridis","year":"2014","journal-title":"J. Thorac. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1111\/joic.12502","article-title":"An updated systematic review and meta-analysis of early outcomes after left atrial appendage occlusion","volume":"31","author":"Yerasi","year":"2018","journal-title":"J. Interv. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"180","DOI":"10.5853\/jos.2018.00780","article-title":"Updates on Prevention of Cardioembolic Strokes","volume":"20","author":"Topcuoglu","year":"2018","journal-title":"J. Stroke"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.jcmg.2015.02.002","article-title":"Percutaneous interventions for left atrial appendage exclusion: Options, assessment, and imaging using 2D and 3D echocardiography","volume":"8","author":"Wunderlich","year":"2015","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_12","first-page":"H1006","article-title":"Compliance of left atrium with and without left atrium appendage","volume":"259","author":"Davis","year":"1990","journal-title":"Am. J. Physiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1136\/hrt.82.5.547","article-title":"Left atrial appendage: Structure, function, and role in thromboembolism","volume":"82","author":"Obel","year":"1999","journal-title":"Heart"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","article-title":"2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS","volume":"37","author":"Kirchhof","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_15","first-page":"245","article-title":"Occurrence of incomplete endothelialization causing residual permeability after left atrial appendage closure","volume":"30","author":"Granier","year":"2018","journal-title":"J. Invasive Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"281","DOI":"10.5853\/jos.2018.02537","article-title":"Percutaneous Left Atrial Appendage Occlusion for the Prevention of Stroke in Patients with Atrial Fibrillation: Review and Critical Appraisal","volume":"20","author":"Schellinger","year":"2018","journal-title":"J. Stroke"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/HCO.0000000000000818","article-title":"Percutaneous left atrial appendage occlusion","volume":"36","author":"Mohammed","year":"2021","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/cvr\/cvy272","article-title":"The prothrombotic state in atrial fibrillation: Pathophysiological and management implications","volume":"115","author":"Khan","year":"2019","journal-title":"Cardiovasc. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S0140-6736(09)60040-4","article-title":"Mechanisms of thrombogenesis in atrial fibrillation: Virchow\u2019s triad revisited","volume":"373","author":"Watson","year":"2009","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"6366","DOI":"10.1038\/s41598-018-24875-1","article-title":"Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling","volume":"8","author":"Seko","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1136\/heartjnl-2012-301799","article-title":"Importance of the underlying substrate in determining thrombus location in atrial fibrillation: Implications for left atrial appendage closure","volume":"98","author":"Mahajan","year":"2012","journal-title":"Heart"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1161\/STROKEAHA.115.012004","article-title":"Atrial Fibrillation and Mechanisms of Stroke: Time for a New Model","volume":"47","author":"Kamel","year":"2016","journal-title":"Stroke"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1093\/eurheartj\/ehv375","article-title":"Novel mechanisms in the pathogenesis of atrial fibrillation: Practical applications","volume":"37","author":"Lau","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_24","first-page":"243","article-title":"Incidence, Prevention, and Management of Periprocedural Complications of Left Atrial Appendage Occlusion","volume":"7","author":"Thakkar","year":"2018","journal-title":"Interv. Cardiol. Clin."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1161\/CIRCIMAGING.111.963892","article-title":"Evaluation of the left atrial appendage with real-time 3-dimensional transesophageal echocardiography: Implications for catheter-based left atrial appendage closure","volume":"4","author":"Nucifora","year":"2011","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.4244\/EIJY19M08_01","article-title":"EHRA\/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion\u2014An update","volume":"15","author":"Glikson","year":"2020","journal-title":"EuroIntervention"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e1076","DOI":"10.4244\/EIJ-D-16-00921","article-title":"Printed MDCT 3D models for prediction of left atrial appendage (LAA) occluder device size: A feasibility study","volume":"13","author":"Goitein","year":"2017","journal-title":"EuroIntervention"},{"key":"ref_28","first-page":"821","article-title":"CT based 3D printing is superior to transesophageal echocardiography for pre-procedure planning in left atrial appendage device closure","volume":"34","author":"Obasare","year":"2018","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1002\/ccd.27514","article-title":"Prospective, randomized comparison of 3-dimensional computed tomography guidance versus TEE data for left atrial appendage occlusion (PRO3DLAAO)","volume":"92","author":"Eng","year":"2018","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Vivoli, G., Gasparotti, E., Rezzaghi, M., Cerone, E., Mariani, M., Landini, L., Berti, S., Positano, V., and Celi, S. (2019). Simultaneous Functional and Morphological Assessment of Left Atrial Appendage by 3D Virtual Models. J. Healthc. Eng., 2019.","DOI":"10.1155\/2019\/7095845"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1111\/echo.13870","article-title":"Evaluation of the left atrial appendage by real time three-dimensional transesophageal echocardiography online","volume":"35","author":"Zhang","year":"2018","journal-title":"Echocardiography"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e4382","DOI":"10.1097\/MD.0000000000004382","article-title":"A meta-analysis for efficacy and safety evaluation of transcatheter left atrial appendage occlusion in patients with nonvalvular atrial fibrillation","volume":"95","author":"Wei","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1016\/j.jacc.2018.01.076","article-title":"Device-Related Thrombosis after Percutaneous Left Atrial Appendage Occlusion for Atrial Fibrillation","volume":"71","author":"Fauchier","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/S0140-6736(09)61343-X","article-title":"Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: A randomised non-inferiority trial","volume":"374","author":"Holmes","year":"2009","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.4244\/EIJY15M01_06","article-title":"Left atrial appendage occlusion for stroke prevention in atrial fibrillation: Multicentre experience with the AMPLATZER Cardiac Plug","volume":"11","author":"Tzikas","year":"2016","journal-title":"EuroIntervention"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1093\/eurheartj\/ehv730","article-title":"Implant success and safety of left atrial appendage closure with the WATCHMAN device: Peri-procedural outcomes from the EWOLUTION registry","volume":"37","author":"Boersma","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jcin.2020.10.034","article-title":"Peridevice Leak Following Amplatzer Left Atrial Appendage Occlusion: Cardiac Computed Tomography Classification and Clinical Outcomes","volume":"14","author":"Korsholm","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1093\/ehjci\/jev067","article-title":"Cardiac CT angiography for device surveillance after endovascular left atrial appendage closure","volume":"16","author":"Saw","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.jcin.2016.11.029","article-title":"Incidence and Clinical Impact of Device-Associated Thrombus and Peri-Device Leak Following Left Atrial Appendage Closure with the Amplatzer Cardiac Plug","volume":"10","author":"Saw","year":"2017","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"172","DOI":"10.14503\/THIJ-18-6693","article-title":"Closure of Left Atrial Appendage to Prevent Stroke: Devices and Status","volume":"45","author":"Rasekh","year":"2018","journal-title":"Tex. Heart Inst. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1080\/14779072.2018.1510316","article-title":"Antithrombotic strategies after interventional left atrial appendage closure: An update","volume":"16","author":"Chen","year":"2018","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1161\/01.CIR.0000015698.54752.6D","article-title":"Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: Early clinical experience","volume":"105","author":"Sievert","year":"2002","journal-title":"Circulation"},{"key":"ref_43","first-page":"571","article-title":"New technology for prevention of embolic events in atrial fibrillation: A systematic review on percutaneous endovascular left atrial appendage closure","volume":"13","author":"Danna","year":"2012","journal-title":"G. Ital. Cardiol."},{"key":"ref_44","first-page":"135","article-title":"European registry data on LAA closure: Advancing the field of interventional stroke prevention","volume":"14","author":"Bergmann","year":"2018","journal-title":"EuroIntervention J. EuroPCR Collab. Work. Group Interv. Cardiol. Eur. Soc. Cardiol."},{"key":"ref_45","first-page":"1106","article-title":"Retrospective Evaluation of Novel Percutaneous Left Atrial Appendage Ligation Using The LARIAT Suturing Device: Single Center Initial Experience","volume":"7","author":"KhodjaevMd","year":"2014","journal-title":"J. Atr. Fibrillation"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Emmert, M.Y., Firstenberg, M.S., Martella, A.T., Lau, L., Zlock, S., Mohan, A., Spangler, T., Currie, S., Salzberg, S.P., and Caliskan, E. (2020). Epicardial left atrial appendage occlusion with a new medical device: Assessment of procedural feasibility, safety and efficacy in a large animal model. J. Cardiothorac. Surg., 15.","DOI":"10.1186\/s13019-020-01096-0"},{"key":"ref_47","first-page":"e590","article-title":"Left atrial appendage occlusion with the AMPLATZER Amulet device: One-year follow-up from the prospective global Amulet observational registry","volume":"14","author":"Landmesser","year":"2018","journal-title":"EuroIntervention J. EuroPCR Collab. Work. Group Interv. Cardiol. Eur. Soc. Cardiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.jcin.2016.04.019","article-title":"Predictors of Early (1-Week) Outcomes Following Left Atrial Appendage Closure With Amplatzer Devices","volume":"9","author":"Koskinas","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1007\/s00392-015-0828-1","article-title":"Early results of first versus second generation Amplatzeroccluders for left atrial appendage closure in patients with atrial fibrillation","volume":"104","author":"Gloekler","year":"2015","journal-title":"Clin. Res. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"867","DOI":"10.4244\/EIJ-D-17-00493","article-title":"Left atrial appendage occlusion with the AMPLATZER Amulet device: Periprocedural and early clinical\/echocardiographic data from a global prospective observational study","volume":"13","author":"Landmesser","year":"2017","journal-title":"EuroIntervention"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.4244\/EIJV11I13A292","article-title":"Left atrial appendage occlusion with the AMPLATZER Amulet device: An expert consensus step-by-step approach","volume":"11","author":"Tzikas","year":"2016","journal-title":"EuroIntervention"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"131","DOI":"10.5603\/CJ.a2017.0017","article-title":"Twelve-month follow-up of left atrial appendage occlusion with Amplatzer Amulet","volume":"24","author":"Kleinecke","year":"2017","journal-title":"Cardiol. J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jacc.2012.06.046","article-title":"Percutaneous left atrial appendage suture ligation using the LARIAT device in patients with atrial fibrillation: Initial clinical experience","volume":"62","author":"Bartus","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1056\/NEJMoa0905561","article-title":"Dabigatran versus warfarin in patients with atrial fibrillation","volume":"361","author":"Connolly","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1056\/NEJMoa1009638","article-title":"Rivaroxaban versus warfarin in nonvalvular atrial fibrillation","volume":"365","author":"Patel","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1056\/NEJMoa1107039","article-title":"Apixaban versus warfarin in patients with atrial fibrillation","volume":"365","author":"Granger","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1056\/NEJMoa1310907","article-title":"Edoxaban versus warfarin in patients with atrial fibrillation","volume":"369","author":"Giugliano","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2014.04.029","article-title":"Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: The PREVAIL trial","volume":"64","author":"Holmes","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2964","DOI":"10.1016\/j.jacc.2017.10.021","article-title":"5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials","volume":"70","author":"Reddy","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1177\/2042098616673990","article-title":"Efficacy and safety of the target-specific oral anticoagulants for stroke prevention in atrial fibrillation: The real-life evidence","volume":"8","author":"Russo","year":"2017","journal-title":"Ther. Adv. Drug Saf."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ijcard.2017.07.048","article-title":"NOACs and atrial fibrillation: Incidence and predictors of left atrial thrombus in the real world","volume":"249","author":"Bertaglia","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1177\/1747493016660100","article-title":"Novel oral anticoagulant management issues for the stroke clinician","volume":"11","author":"Wassef","year":"2016","journal-title":"Int. J. Stroke"},{"key":"ref_63","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":"ref_64","doi-asserted-by":"crossref","first-page":"2614","DOI":"10.1016\/j.jacc.2015.04.025","article-title":"Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: A Patient-Level Meta-Analysis","volume":"65","author":"Holmes","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1016\/j.jcin.2015.08.035","article-title":"Bleeding Outcomes After Left Atrial Appendage Closure Compared With Long-Term Warfarin: A Pooled, Patient-Level Analysis of the WATCHMAN Randomized Trial Experience","volume":"8","author":"Price","year":"2015","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.ahj.2016.10.003","article-title":"Interventional left atrial appendage closure vs novel anticoagulation agents in patients with atrial fibrillation indicated for long-term anticoagulation (PRAGUE-17 study)","volume":"183","author":"Osmancik","year":"2017","journal-title":"Am. Heart J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/j.hrthm.2015.12.037","article-title":"Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: The PREVAIL triales","volume":"13","author":"Li","year":"2016","journal-title":"Heart Rhythm"},{"key":"ref_68","unstructured":"Health Quality Ontario (2017). Left Atrial Appendage Closure Device with Delivery System: A Health Technology Assessment. Ont. Health Technol. Assess. Ser, 17, 1\u2013106."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s10840-015-9988-1","article-title":"Left atrial appendage occlusion for prevention of stroke in nonvalvular atrial fibrillation: A meta-analysis","volume":"43","author":"Bode","year":"2015","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1136\/heartjnl-2016-309782","article-title":"Efficacy and safety of left atrial appendage closure versus medical treatment in atrial fibrillation: A network meta-analysis from randomised trials","volume":"103","author":"Sahay","year":"2017","journal-title":"Heart"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.4244\/EIJV15I13A207","article-title":"Left atrial appendage occlusion for stroke prevention\u2014State of the art as provided in an updated EHRA\/EAPCI consensus statement and future perspectives","volume":"15","author":"Skurk","year":"2020","journal-title":"EuroIntervention"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.amjcard.2017.04.046","article-title":"Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation and Previous Major Gastrointestinal Bleeding (from the Amplatzer Cardiac Plug Multicenter Registry)","volume":"120","author":"Lempereur","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1378\/chest.15-1719","article-title":"Stroke, Major Bleeding, and Mortality Outcomes in Warfarin Users with Atrial Fibrillation and Chronic Kidney Disease: A Meta-Analysis of Observational Studies","volume":"149","author":"Dahal","year":"2016","journal-title":"Chest"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1016\/j.hrthm.2018.09.012","article-title":"Electrical isolation of the left atrial appendage increases the risk of ischemic stroke and transient ischemic attack regardless of postisolation flow velocity","volume":"15","author":"Kim","year":"2018","journal-title":"Heart Rhythm"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1093\/europace\/euw007","article-title":"Concomitant cryoballoon ablation and percutaneous closure of left atrial appendage in patients with atrial fibrillation","volume":"18","author":"Fassini","year":"2016","journal-title":"Europace"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1093\/europace\/euy025","article-title":"Combined atrial fibrillation ablation and left atrial appendage closure: Long-term follow-up from a large multicentre registry","volume":"20","author":"Wintgens","year":"2018","journal-title":"Europace"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/5\/444\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:56:57Z","timestamp":1760162217000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/5\/444"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,3]]},"references-count":76,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["medicina57050444"],"URL":"https:\/\/doi.org\/10.3390\/medicina57050444","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,3]]}}}