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. LakkireddyDouglas N. Gibson, Andrea Natale, Vivek Y. Reddy

Research output: Contribution to journalArticle

36 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Enomoto, Y., Gadiyaram, V. K., Gianni, C., Horton, R. P., Trivedi, C., Mohanty, S., Di Biase, L., Al-Ahmad, A., Burkhardt, J. D., Narula, A., Janczyk, G., Price, M. J., Afzal, M. R., Atoui, M., Earnest, M., Swarup, V., Doshi, S. K., van der Zee, S., Fisher, R., ... 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