# Should the Left Atrial Appendage Closure (LAAC) Technique Be the Main Form of Stroke Prevention in Patients With Long-Standing Persistent or Permanent Atrial Fibrillation?

## TL;DR

This paper discusses whether left atrial appendage closure should replace oral anticoagulants for stroke prevention in patients with long-standing atrial fibrillation.

## Contribution

The paper presents a case report advocating for left atrial appendage closure as a safer alternative to oral anticoagulants in high-risk patients.

## Key findings

- Left atrial appendage closure can be a viable option for stroke prevention in patients who experience adverse effects from oral anticoagulants.
- The case report highlights successful use of the procedure in a patient with long-standing persistent atrial fibrillation.
- Physicians should reconsider current practices and consider device-based solutions for stroke prevention in high-risk patients.

## Abstract

Currently, oral anticoagulants are considered the gold standard for stroke prevention in patients with atrial fibrillation. Despite the efficacy of oral anticoagulants in reducing stroke incidence, patients are at risk of developing adverse reactions such as excessive bleeding and bruising, and can also have drug-drug interactions. In the early 2000s, a minimally invasive technique called the left atrial appendage closure emerged as an alternative for stroke prevention in atrial fibrillation patients who could not tolerate oral anticoagulants. Despite the success of the left atrial appendage closure, practitioners still opt for medication therapy and are reluctant to advocate for this procedure. Given the adverse effects of oral anticoagulants, physicians should question if this is the appropriate method of stroke prevention in long-standing persistent or permanent atrial fibrillation patients. This case report investigates an 82-year-old Middle Eastern male in the United States with long-standing persistent atrial fibrillation who underwent a left atrial appendage closure due to recurrent bleeding on oral anticoagulants. In addition, there will be further discussion on the appropriate method of stroke prevention in similar patients.