New technical and anticoagulation aspects for left atrial appendage closure using the WATCHMAN® device in patients not taking warfarin

Abstract

Our data suggest that DAPT can be used safely during the first 45 days in patients with contraindications to warfarin. An algorithm employing larger devices in relation to the LAA ostium with consecutively larger compression improved procedural safety compared to the current standard regarding leakage and device repositioning.

Left atrial appendage closure (WATCHMAN™) after bleeding complications during oral anticoagulant therapy in high risk patients

“…Therefore Reddy et al analyzed a dual antiplatelet therapy with aspirin and clopidogrel after implantation of a WATCHMAN™ device and demonstrated that LAA-closure with a WATCHMAN™ device can be safely performed without Warfarin transition. 6 A dual antiplatelet therapy for 45 days after LAA-closure was also shown to be a safe alternative strategy by Meincke et al 9 The clinical focus of our prospective analysis was to check other possibilities of anticoagulant therapy after LAA-closure and to describe the rate of major adverse events defined as stroke and systemic embolism or major bleeding requiring invasive treatment or blood transfusion in patients with atrial fibrillation and a CHADS 2 score 1 with severe bleeding in anamnesis.…”

“…7 After LAA-closure patients received a dual antiplatelet therapy with aspirin and clopidogrel (100 mg of aspirin and 75 mg clopidogrel per day) for 6 weeks, followed by a monotherapy with 100 mg of aspirin per day, as the results of four GLP (good laboratory practices) studies indicated the endothelial overgrowth within 45 days 8 and safety of this medical strategy was demonstrated in another clinical trial. 9 Over the next 9 ± 3 months the patients were followed-up regarding complications as severe bleedings or strokes. A case history of the patient with screening for ischemic or bleeding events was noted and a transoesophageal echocardiography was performed 6 weeks, 6 and 12 months after the implantation of the WATCHMAN™ device to assess device position, peri-device LAA flow and device-related thrombi.…”

Rules and Principles of Patient Selection for Surgical Treatment of Acquired Heart Diseases Complicated by Atrial Fibrillation

“…Другим путем развития подобных устройств явля-ются эндоваскулярные окклюдеры (например, Watchman, Boston Scientific) [18], однако до сих пор они не показа-ли существенного преимущества своего применения по сравнению с пероральными непрямыми антикоагулянта-ми [19]. При этом сопоставимые с приемом антикоагу-лянтов результаты достигаются либо превышением раз-мера окклюдера от нормативного [20], либо назначением двойной дезагрегантной терапии после имплантации окклюдера [21].…”

Oclusão Percutânea do Apêndice Atrial Esquerdo com Prótese Watchman®

“…11 Assim como aconteceu com outros procedimentos intervencionistas, houve melhora significativa na segurança da oclusão do AAE com o dispositivo Watchman ® , com aumento da experiência dos operadores. [10][11][12] Nosso estudo mostrou resultados iniciais dos desfechos clínicos relativos à segurança da prótese e da intervenção bastante satisfatórios, em procedimentos realizados em um hospital familiarizado com procedimentos estruturais e sob a supervisão de médicos certificados. No seguimento, um paciente apresentou trombo no dispositivo, o que levanta questão a respeito de sua incidência, sua implicação clínica e seu manuseio.…”

“…Não existiram quaisquer fenômenos tromboembólicos nesse grupo de pacientes. 12 No nosso paciente, o trombo foi localizado de maneira similar, acima e no centro do dispositivo, sem envolver o triângulo relativo à borda superior da veia pulmonar. Não ocorreram eventos importantes, mas foi necessário iniciar e manter a anticoagulação por mais 3 meses, mesmo sem evidência clínica para tal.…”