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

Enomoto, Yoshinari; Gadiyaram, Varuna; Gianni, Carola; Horton, Rodney; Trivedi, Chintan; Mohanty, Sanghamitra; Biase, Luigi Di; Al‐Ahmad, Amin; Burkhardt, J. David; Narula, Arvin; Janczyk, Gwen; Price, Matthew J.; Afzal, Muhammad R.; Atoui, Moustapha; Earnest, Matthew; Swarup, Vijay; Doshi, Shephal K.; Zee, Sarina van der; Fisher, Rebecca; Lakkireddy, Dhanunjaya; Gibson, Douglas; Natale, Andrea; Reddy, Vivek Y.

doi:10.1016/j.hrthm.2016.10.020

Cited by 99 publications

(63 citation statements)

References 13 publications

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“…A small study 10 showed no DRT at 45 days after the WATCHMAN procedure in patients treated with a NOAC. A more recent and larger registry study 11 examining 214 patients who received one of the NOAC drugs after the WATCHMAN procedure showed no difference in DRT or ischemic events during follow-up as compared to a matched warfarin group.…”

Section: Discussionmentioning

confidence: 95%

Termination of anticoagulation therapy at 45 days after concomitant atrial fibrillation catheter ablation and left atrial appendage occlusion resulting in device-related thrombosis and stroke

Carlson

Doshi

2017

HeartRhythm Case Reports

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Section: Discussionmentioning

confidence: 95%

Termination of anticoagulation therapy at 45 days after concomitant atrial fibrillation catheter ablation and left atrial appendage occlusion resulting in device-related thrombosis and stroke

Carlson

Doshi

2017

HeartRhythm Case Reports

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“…In current clinical practice, a shortened regimen of 45 days DAPT followed by ASA alone for 6 months is also used . In a recent study, NOAC‐only use after LAA closure appears to be safe . During a concomitant procedure, at least 8 weeks of anticoagulation were aimed for, if clinically feasible for the individual patient.…”

Section: Discussionmentioning

confidence: 99%

Long‐term follow‐up after left atrial appendage occlusion with comparison of transesophageal echocardiography versus computed tomography to guide medical therapy and data about postclosure cardioversion

Berte

Jost

Maurer

et al. 2017

Cardiovasc electrophysiol

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“…Furthermore, DOAC or single antiplatelet therapy may be preferable to VKA therapy for use in patients with history of ICH during the period of device endothelialization following LAAC. A multicenter observational cohort study involving 214 patients who received DOAC following LAAC reported an extremely low rate of DRT, suggesting this approach is safe and feasible . The ongoing A3ICH (Avoiding Anticoagulation After Intracerebral Hemorrhage trial; NCT03243175) is randomizing patients with history of ICH 1:1:1 to treatment with LAAC, no anticoagulation, or apixiban (Table ).…”

Section: Laac and Doac In Unique Subgroupsmentioning

confidence: 99%

“…The ideal choice and duration of OAC for treatment of DRT is unknown. Although observational data suggest that DOAC perform similarly to VKA with respect to prevention of DRT and its thromboembolic complications, use of DOAC following LAAC will need to be evaluated in prospective clinical trials …”

Section: Laac and Doac In Unique Subgroupsmentioning

confidence: 99%

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

Black‐Maier

Piccini

Granger

2019

Cardiovasc electrophysiol

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Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and confers a fivefold increased risk for stroke. Cardioembolic stroke secondary to AF is a devastating event, but is largely preventable with appropriate oral anticoagulation (OAC). The PROTECT and PREVAIL trials demonstrated that the WATCHMAN left atrial appendage closure (LAAC) device in combination with short‐term warfarin therapy is noninferior to long‐term warfarin with respect to a composite endpoint of stroke, cardiovascular death, and systemic embolism. Importantly, the WATCHMAN confers a significant reduction in life‐threatening bleeding compared to OAC. Although direct‐acting oral anticoagulant (DOAC) are superior to warfarin in eligible patients, several important AF populations exist in whom left atrial appendage (LAA) closure may be preferable to DOAC. Populations warranting strong consideration of LAAC include patients with contraindications to DOAC, end‐stage renal disease, prior intracranial hemorrhage, recurrent gastrointestinal bleeding, and patients undergoing transcatheter aortic valve replacement or left atrial electrical isolation. Device‐related thrombosis is an important complication of LAAC, and DOAC may be preferential to warfarin for prevention and treatment of this complication remains unexplored. Prospective clinical trials comparing DOAC to LAAC in these unique populations are either ongoing or needed.

show abstract

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

Cited by 99 publications

References 13 publications

Termination of anticoagulation therapy at 45 days after concomitant atrial fibrillation catheter ablation and left atrial appendage occlusion resulting in device-related thrombosis and stroke

Termination of anticoagulation therapy at 45 days after concomitant atrial fibrillation catheter ablation and left atrial appendage occlusion resulting in device-related thrombosis and stroke

Long‐term follow‐up after left atrial appendage occlusion with comparison of transesophageal echocardiography versus computed tomography to guide medical therapy and data about postclosure cardioversion

Left atrial appendage closure: A therapy uniquely suited for specific populations of patients with atrial fibrillation

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