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

Yoshinari Enomoto, Varuna K. Gadiyaram, Carola Gianni, Rodney P. Horton, Chintan Trivedi, Sanghamitra Mohanty, Luigi Di Biase, Amin Al-Ahmad, J. David Burkhardt, Arvin Narula, Gwen Janczyk, Matthew J. Price, Muhammad R. Afzal, Moustapha Atoui, Matthew Earnest, Vijay Swarup, Shephal K. Doshi, Sarina van der Zee, Rebecca Fisher, Dhanunjaya R. Lakkireddy & 3 others Douglas N. Gibson, Andrea Natale, Vivek Y. Reddy

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)19-24
Number of pages6
JournalHeart Rhythm
Volume14
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Atrial Appendage
Warfarin
Anticoagulants
Equipment and Supplies
Thrombosis
Hemorrhage
Thromboembolism
Transesophageal Echocardiography
Feasibility Studies
Multicenter Studies
Thorax
Retrospective Studies
Stroke
Tomography
Safety
Control Groups

Keywords

  • Device-related thrombosis
  • Left atrial appendage
  • Non-warfarin oral anticoagulants
  • Stroke
  • Thromboembolism
  • Watchman

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Enomoto, Y., Gadiyaram, V. K., Gianni, C., Horton, R. P., Trivedi, C., Mohanty, S., ... Reddy, V. Y. (2017). Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device. Heart Rhythm, 14(1), 19-24. https://doi.org/10.1016/j.hrthm.2016.10.020

Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device. / Enomoto, Yoshinari; Gadiyaram, Varuna K.; Gianni, Carola; Horton, Rodney P.; Trivedi, Chintan; Mohanty, Sanghamitra; Di Biase, Luigi; 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.; van der Zee, Sarina; Fisher, Rebecca; Lakkireddy, Dhanunjaya R.; Gibson, Douglas N.; Natale, Andrea; Reddy, Vivek Y.

In: Heart Rhythm, Vol. 14, No. 1, 01.01.2017, p. 19-24.

Research output: Contribution to journalArticle

Enomoto, Y, Gadiyaram, VK, Gianni, C, Horton, RP, Trivedi, C, Mohanty, S, Di Biase, L, Al-Ahmad, A, Burkhardt, JD, Narula, A, Janczyk, G, Price, MJ, Afzal, MR, Atoui, M, Earnest, M, Swarup, V, Doshi, SK, van der Zee, S, Fisher, R, Lakkireddy, DR, Gibson, DN, Natale, A & Reddy, VY 2017, 'Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device', Heart Rhythm, vol. 14, no. 1, pp. 19-24. https://doi.org/10.1016/j.hrthm.2016.10.020
Enomoto, Yoshinari ; Gadiyaram, Varuna K. ; Gianni, Carola ; Horton, Rodney P. ; Trivedi, Chintan ; Mohanty, Sanghamitra ; Di Biase, Luigi ; 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. ; van der Zee, Sarina ; Fisher, Rebecca ; Lakkireddy, Dhanunjaya R. ; Gibson, Douglas N. ; Natale, Andrea ; Reddy, Vivek Y. / Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device. In: Heart Rhythm. 2017 ; Vol. 14, No. 1. pp. 19-24.
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title = "Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device",
abstract = "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.",
keywords = "Device-related thrombosis, Left atrial appendage, Non-warfarin oral anticoagulants, Stroke, Thromboembolism, Watchman",
author = "Yoshinari Enomoto and Gadiyaram, {Varuna K.} and Carola Gianni and Horton, {Rodney P.} and Chintan Trivedi and Sanghamitra Mohanty and {Di Biase}, Luigi and Amin Al-Ahmad and Burkhardt, {J. David} and Arvin Narula and Gwen Janczyk and Price, {Matthew J.} and Afzal, {Muhammad R.} and Moustapha Atoui and Matthew Earnest and Vijay Swarup and Doshi, {Shephal K.} and {van der Zee}, Sarina and Rebecca Fisher and Lakkireddy, {Dhanunjaya R.} and Gibson, {Douglas N.} and Andrea Natale and Reddy, {Vivek Y.}",
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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.

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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DO - 10.1016/j.hrthm.2016.10.020

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