Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device

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• 作者：Yoshinari Enomoto ; MD^* ; Varuna K. Gadiyaram ; MD^&dagger ; ; Carola Gianni ; MD ; PhD^&Dagger ; ; ^§ ; ; Rodney P. Horton ; MD ; FHRS^&Dagger ; ; ^¶ ; ; Chintan Trivedi ; MD ; MPH ; FHRS^&Dagger ; ; Sanghamitra Mohanty ; MD ; MBBS ; MS ; FHRS^&Dagger ; ; ^║ ; Luigi Di Biase ; MD ; PhD ; FHRS^&Dagger ; ; ^¶ ; ; ^** ; ^&dagger ; &dagger ; ; Amin Al-Ahmad ; MD ; CCSD ; FHRS^&Dagger ; ; J. David Burkhardt ; MD ; FHRS^&Dagger ; ; Arvin Narula ; MD^&dagger ; ; Gwen Janczyk ; PAC^&dagger ; ; Matthew J. Price ; MD^&dagger ; ; Muhammad R. Afzal ; MD^&Dagger ; &Dagger ; ; Moustapha Atoui ; MD^&Dagger ; &Dagger ; ; Matthew Earnest ; MD^&Dagger ; &Dagger ; ; Vijay Swarup ; MD ; FHRS^§ ; § ; ; Shephal K. Doshi ; MD^¶ ; ¶ ; ; Sarina van der Zee ; MD^¶ ; ¶ ; ; Rebecca Fisher ; MD^* ; Dhanunjaya R. Lakkireddy ; MD^&Dagger ; &Dagger ; ; Douglas N. Gibson ; MD ; FHRS^&dagger ; ; Andrea Natale ; MD ; FHRS^&dagger ; ; ^&Dagger ; ; ^¶ ; ; ^║ ; ^║║ ; ^*** ; ^&dagger ; &dagger ; &dagger ; ; Vivek Y. Reddy ; MD^‬* ; ^{vivek.reddy@mountsinai.org}
• 关键词：Left atrial appendage ; Watchman ; Non-warfarin oral anticoagulants ; Device-related thrombosis ; Thromboembolism ; Stroke
• 刊名：Heart Rhythm
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：14
• 期：1
• 页码：19-24
• 全文大小：279 K
• 卷排序：14

文摘

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.ObjectiveGiven 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.MethodsThis 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.ResultsIn 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.ConclusionNOACs 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.