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Not all thromboembolism comes from the left atrial appendage in atrial fibrillation
  1. Keitaro Senoo1,
  2. Gregory Y H Lip1,2
  1. 1University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
  2. 2Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  1. Correspondence to Professor Gregory Y H Lip, University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK; g.y.h.lip{at}

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Atrial fibrillation (AF) confers a substantial risk of stroke and thromboembolism, which is effectively reduced by oral anticoagulation (OAC), whether as a vitamin K antagonist (VKA, eg, warfarin) or one of non-VKA oral anticoagulants (NOACs). With the use of OACs, the risk of bleeding remains a problem associated with these agents. Thus, a clinical dilemma remains in the optimal management of patients with AF who are at high risk of stroke but have a history of bleeding.

Among patients with non-valvular AF, over 90% of the thrombus is formed in the left atrial appendage (LAA).1 Thus, the exclusion of LAA could greatly decrease the risk of stroke in patients with AF, given that blood stasis in a fibrillating LAA is likely to lead to thrombus formation. Interventional devices to occlude the LAA are not ‘new’ and various LAA closure devices have been available for years. More recently, the Watchman (Atritech) and Amplatzer Cardiac Plug (ACP) device (St Jude Medical) are the more widely used ones in clinical practice.


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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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