Stöllberger Claudia, Finsterer Josef, Schneider Birke
Klinik Landstraße Wien Austria.
Sana Kliniken Lübeck Lübeck Germany.
Clin Case Rep. 2023 Jun 26;11(6):e7630. doi: 10.1002/ccr3.7630. eCollection 2023 Jun.
Left-atrial-appendage-closure (LAAC) is suggested as alternative to antiplatelet/anticoagulant therapy (AP/AC) for stroke-prevention in patients with cerebral-amyloid-angiopathy (CAA), intracerebral hemorrhage (ICH) and atrial fibrillation (AF). Disadvantages of LAAC are the need for postinterventional AP and impairment of left atrial function, thus promoting heart-failure. Therefore, in an 83-year-old edoxaban-treated AF-patient with ICH and CAA, only antihypertensive therapy with neither AP/AC nor LAAC was recommended. Twenty-seven months without stroke/ICH support this strategy, which needs confirmation by a randomized-trial.
对于患有脑淀粉样血管病（CAA）、脑出血（ICH）和心房颤动（AF）的患者，左心耳封堵术（LAAC）被认为是抗血小板/抗凝治疗（AP/AC）预防中风的替代方案。LAAC的缺点是介入后需要进行抗血小板治疗以及左心房功能受损，进而会引发心力衰竭。因此，对于一名接受依度沙班治疗、患有ICH和CAA的83岁房颤患者，仅建议采用既不进行AP/AC也不进行LAAC的抗高血压治疗。27个月未发生中风/ICH支持了这一策略，该策略需要通过随机试验来证实。
