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In the developed countries, stroke is an important cause of mortality and disability. Cardioembolism is the most frequent cause of ischaemic stroke, in the presence of atrial fibrillation (AF).1 AF is the most common cardiac arrhythmia in the general population and its prevalence increases with age; the lifetime risk of AF development is 25% in people over 40 years old.2 Anticoagulation has been established as an effective treatment strategy for stroke prevention in patients with AF and risk factors for stroke.3 The new oral anticoagulants (NOACs) seem to be similarly efficacious compared with vitamin K antagonists (VKAs) but with a decreased risk for intracranial bleeding.4 Despite the more safe profile of the NOACs, there remain patients with AF at risk for stroke, but with a contraindication for any form of anticoagulation or at high risk of bleeding (eg, non-treatable digestive bleeding). Furthermore, the patients with high risk of cardioembolic stroke based on CHA2DS2-VASc score also have a high risk for bleeding as determined with the HASBLED score, given the presence of the same risk factors in both scores as hypertension, previous stroke or age >65 years. The risk of stroke secondary to non-valvular AF is mainly secondary to thrombus development in the left atrial appendage (LAA).5 The exclusion of LAA has been …
Competing interests The Cardiology Department receives proctoring fees for training/educational services from Boston Scientific.
Patient consent Obtained.
Provenance and peer review Commissioned; internally peer reviewed.
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