A comparison of postprocedural anticoagulation in high‐risk patients undergoing WATCHMAN device implantation

Autor:	Joshua Cohen, Jennifer Galvin, Rahul Sakhuja, Moussa Mansour, Matthew S. Johnson, Jeremy N. Ruskin, Danita M. Yoerger Sanborn, Jacob P. Dal-Bianco, Grace Ha, E. Kevin Heist, Jacqueline S. Danik, Brian B. Ghoshhajra, M. Edip Gurol, Margaux Forsch, Linsheng Shi, Judy Hung, Michael G. Fitzsimons, Kathryn Slattery, Hang Lee
Rok vydání:	2019
Předmět:	Male medicine.medical_specialty Septal Occluder Device Administration Oral 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Left atrial Atrial Fibrillation medicine Humans Atrial Appendage 030212 general & internal medicine Stroke Aged High risk patients business.industry Incidence (epidemiology) Warfarin Anticoagulants Atrial fibrillation General Medicine medicine.disease Surgery Female Cardiology and Cardiovascular Medicine business Major bleeding medicine.drug
Zdroj:	Pacing and Clinical Electrophysiology. 42:1304-1309
ISSN:	1540-8159 0147-8389
DOI:	10.1111/pace.13796
Popis:	Background Left atrial appendage closure (LAAC) is an alternative to long-term anticoagulation for thromboembolic protection in patients with atrial fibrillation (AF) and high bleeding risk. Short-term Warfarin use following LAAC is well-studied, while data pertaining to novel oral anticoagulant (NOAC) use in this setting is less robust. Specifically, data regarding the safety and efficacy of postprocedural NOAC use in high-risk patients is lacking. Objective To compare the safety and efficacy of Warfarin and NOAC use in a high-risk patient population undergoing LAAC with the WATCHMAN device. Methods From November 2015 to October 2017, 97 patients underwent LAAC with the WATCHMAN device. All patients were discussed at a multidisciplinary meeting prior to device implantation. Longitudinal data were collected and analyzed for a composite endpoint of stroke and death at 8 months, and major bleeding at 3 and 6 months. Results Among the 90 patients included in the safety and efficacy analysis, 43 were prescribed Warfarin and 47 were prescribed NOACs. Baseline characteristics were comparable between study groups. There were no procedural complications and no significant differences in the incidence of death and stroke at 8 months or major bleeding at 3 and 6 months. Conclusion For patients with AF at high risk of both thromboembolic and hemorrhagic events, NOACs as compared to Warfarin, seem to be safe and effective for short-term anticoagulation following LAAC with the WATCHMAN device. Further validation in large randomized controlled trials is required.
Databáze:	OpenAIRE
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