000			03414nam a2200373 4500
001			ESSALUD
005			20260819163736.0
007			ta
008			t pe ||||| |||| 00| 0 spa d
040			_aBMG
041			_aeng
100			_aDoshi, Shephal K. _eAutor _954162
245			_aLeft atrial appendage closure or anticoagulation for atrial fibrillation
300			_apáginas: 2083-2094
520			_aBackground: For patients with atrial fibrillation, the use of oral anticoagulant therapy to prevent stroke is limited by the risk of bleeding. Left atrial appendage closure is considered for patients who are unsuitable candidates for long-term anticoagulation, but its role in patients who are eligible for anticoagulants has not been established. Methods: In this ongoing, prospective, international, randomized trial involving patients with atrial fibrillation who were suitable candidates for anticoagulation, we randomly assigned patients in a 1:1 ratio to receive either device-based left atrial appendage closure (device group) or non–vitamin K antagonist oral anticoagulant (NOAC) therapy (anticoagulation group). The primary efficacy end point — a composite of death from cardiovascular causes, stroke, or systemic embolism — was tested for noninferiority (noninferiority margin, 4.8 percentage points) after 3 years of follow-up. The primary safety end point, non–procedure-related bleeding, was tested for superiority. Results: Of the 3000 patients who underwent randomization, 1499 were assigned to the device group and 1501 to the anticoagulation group. The mean (±SD) age of the patients was 71.7±7.5 years, 31.9% of the patients were women, and the mean CHA2DS2-VASc score was 3.5±1.3. At 3 years, a primary efficacy end-point event had occurred in 81 patients (Kaplan–Meier estimate, 5.7%) in the device group and in 65 patients (Kaplan–Meier estimate, 4.8%) in the anticoagulation group (difference, 0.9 percentage points; 95% confidence interval [CI], −0.8 to 2.6; P<0.001 for noninferiority). Non–procedure-related bleeding occurred in 154 patients (Kaplan–Meier estimate, 10.9%) in the device group and in 260 patients (Kaplan–Meier estimate, 19.0%) in the anticoagulation group (hazard ratio, 0.55; 95% CI, 0.45 to 0.67; P<0.001 for superiority). Conclusions: Among patients with atrial fibrillation who were candidates for anticoagulation, device-based left atrial appendage closure was noninferior to NOAC therapy with respect to a composite of death from cardiovascular causes, stroke, or systemic embolism and was superior to NOAC therapy for non–procedure-related bleeding at 3 years.
650			_aANTICOAGULACIÓN _953834
650			_aTROMBOEMBOLISMO _932218
650			_aARRITMIAS _953863
650			_aCARDIOLOGÍA _911301
650			_aMARCAPASOS _953864
650			_aDESFIBRILADORES _953865
700			_aKar, Saibal _954163
700			_aNair, Devi G. _953867
700			_aWaggoner, Thomas _954164
700			_aAgarwal, Himanshu _954165
700			_aMoussavian, Mehran _954166
700			_aKashani, Amir _954167
700			_aOza, Saumil _954168
700			_aFeldman, Leon _954169
700			_aSadhu, Ashish _954170
700			_aDeLurgio, David _954171
773	0		_022717 _922648 _dMassachusetts NEJM Group _oNEJM011 _tThe New England Journal of Medicine _wESSALUD _x0028-4793
942			_cARTICULOS _e2026-08-19 _zsqb
999			_c22833 _d22833