TY - JOUR
T1 - Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device
AU - Enomoto, Yoshinari
AU - Gadiyaram, Varuna K.
AU - Gianni, Carola
AU - Horton, Rodney P.
AU - Trivedi, Chintan
AU - Mohanty, Sanghamitra
AU - Di Biase, Luigi
AU - Al-Ahmad, Amin
AU - Burkhardt, J. David
AU - Narula, Arvin
AU - Janczyk, Gwen
AU - Price, Matthew J.
AU - Afzal, Muhammad R.
AU - Atoui, Moustapha
AU - Earnest, Matthew
AU - Swarup, Vijay
AU - Doshi, Shephal K.
AU - van der Zee, Sarina
AU - Fisher, Rebecca
AU - Lakkireddy, Dhanunjaya R.
AU - Gibson, Douglas N.
AU - Natale, Andrea
AU - Reddy, Vivek Y.
N1 - Publisher Copyright:
© 2016 Heart Rhythm Society
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background In the stroke prevention trials of left atrial appendage closure with the Watchman device (Boston Scientific), a postimplantation antithrombotic regimen of 6 weeks of warfarin was used. Objective Given the clinical complexity of warfarin use, the purpose of this study was to study the relative feasibility and safety of using non-warfarin oral anticoagulants (NOACs) instead of warfarin during the peri- and initial postimplantation periods after Watchman implantation. Methods This was a retrospective multicenter study of consecutive patients undergoing Watchman implantation and receiving peri- and postprocedural NOACs or warfarin. Transesophageal echocardiography or chest computed tomography was performed between 6 weeks and 4 months postimplant to assess for device-related thrombosis. Bleeding and thromboembolic events also were evaluated at the time of follow-up. Results In 5 centers, 214 patients received NOACs (46% apixaban, 46% rivaroxaban, 7% dabigatran, and 1% edoxaban) in either an uninterrupted (82%) or a single-held-dose (16%) fashion. Compared to a control group receiving uninterrupted warfarin (n = 212), the rates of periprocedural complications, including bleeding events, were similar (2.8% vs 2.4%, P = 1). At follow-up, the rates of device-related thrombosis (0.9% vs 0.5%, P = 1), composite of thromboembolism or device-related thrombosis (1.4% vs 0.9%, P = 1), and postprocedure bleeding events (0.5% vs 0.9%, P =.6) also were comparable between the NOAC and warfarin groups. Conclusion NOACs proved to be a feasible peri- and postprocedural alternative regimen to warfarin for preventing device-related thrombosis and thromboembolic complications expected early after appendage closure with the Watchman device, without increasing the risk of bleeding.
AB - Background In the stroke prevention trials of left atrial appendage closure with the Watchman device (Boston Scientific), a postimplantation antithrombotic regimen of 6 weeks of warfarin was used. Objective Given the clinical complexity of warfarin use, the purpose of this study was to study the relative feasibility and safety of using non-warfarin oral anticoagulants (NOACs) instead of warfarin during the peri- and initial postimplantation periods after Watchman implantation. Methods This was a retrospective multicenter study of consecutive patients undergoing Watchman implantation and receiving peri- and postprocedural NOACs or warfarin. Transesophageal echocardiography or chest computed tomography was performed between 6 weeks and 4 months postimplant to assess for device-related thrombosis. Bleeding and thromboembolic events also were evaluated at the time of follow-up. Results In 5 centers, 214 patients received NOACs (46% apixaban, 46% rivaroxaban, 7% dabigatran, and 1% edoxaban) in either an uninterrupted (82%) or a single-held-dose (16%) fashion. Compared to a control group receiving uninterrupted warfarin (n = 212), the rates of periprocedural complications, including bleeding events, were similar (2.8% vs 2.4%, P = 1). At follow-up, the rates of device-related thrombosis (0.9% vs 0.5%, P = 1), composite of thromboembolism or device-related thrombosis (1.4% vs 0.9%, P = 1), and postprocedure bleeding events (0.5% vs 0.9%, P =.6) also were comparable between the NOAC and warfarin groups. Conclusion NOACs proved to be a feasible peri- and postprocedural alternative regimen to warfarin for preventing device-related thrombosis and thromboembolic complications expected early after appendage closure with the Watchman device, without increasing the risk of bleeding.
KW - Device-related thrombosis
KW - Left atrial appendage
KW - Non-warfarin oral anticoagulants
KW - Stroke
KW - Thromboembolism
KW - Watchman
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U2 - 10.1016/j.hrthm.2016.10.020
DO - 10.1016/j.hrthm.2016.10.020
M3 - Article
C2 - 27771552
AN - SCOPUS:85006341335
SN - 1547-5271
VL - 14
SP - 19
EP - 24
JO - Heart Rhythm
JF - Heart Rhythm
IS - 1
ER -