WATCHMAN implantation in patients with a history of atrial fibrillation and intracranial hemorrhage

William J. Hucker, Joshua A. Cohen, M. Edip Gurol, E. Kevin Heist, Carola Gianni, Jennifer Galvin, Donita Atkins, Sudha Bommana, Luigi Di Biase, Jeremy Ruskin, Sanghamitra Mohanty, Rodney Horton, Dhanunjaya Lakkireddy, Andrea Natale, Moussa Mansour

Research output: Contribution to journalArticle

Abstract

Purpose: Use of oral anticoagulation (OAC) in patients with a history of intracranial hemorrhage (ICH) is often considered high risk as OAC-related ICH is associated with high mortality rates. Left atrial appendage closure with a WATCHMAN device is an alternative management strategy to OAC to decrease thrombotic risk in atrial fibrillation patients; however use of OAC followed by dual antiplatelet therapy (DAPT) or DAPT therapy alone is required for 6 months post-procedurally. In this study, we examined the safety of WATCHMAN implantation followed by 6 months of anti-thrombotic therapy in patients with a history of ICH. Methods: This is a retrospective analysis of 63 patients with a history of ICH prior to WATCHMAN implantation (Group I) and 95 patients without a history of ICH who underwent WATCHMAN placement (Group II). The primary outcome was death, stroke, or major bleeding within 6 months of WATCHMAN placement. Results: The average CHA2DS2-VASc of Group I was 4.9 ± 1.7 vs 4.7 ± 1.4 for Group II (p = 0.34). The most common type of ICH in Group I was an intracerebral hemorrhage (57%). The median time between ICH and WATCHMAN implantation in Group I patients was 212 days. A total of 19% of Group I patients were managed with DAPT alone post-procedurally vs. 3% in Group II (p < 0.001). Similar to 89% of Group II (p = 0.19), 95% of Group I patients were free of the primary outcome at 6 months. No Group I patients had recurrent ICH within 6 months after WATCHMAN implantation. Conclusion: In a retrospective, multicenter series of patients with a history of ICH prior to WATCHMAN implantation, WATCHMAN placement was performed safely with 6-month outcomes that were similar to patients without a history of ICH, encompassing the time during which a patient with a history of ICH would need antithrombotic therapy to facilitate WATCHMAN placement.

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Jan 1 2019

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Keywords

  • Atrial fibrillation
  • Intracranial hemorrhage
  • Left atrial appendage closure
  • WATCHMAN

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hucker, W. J., Cohen, J. A., Gurol, M. E., Heist, E. K., Gianni, C., Galvin, J., Atkins, D., Bommana, S., Di Biase, L., Ruskin, J., Mohanty, S., Horton, R., Lakkireddy, D., Natale, A., & Mansour, M. (Accepted/In press). WATCHMAN implantation in patients with a history of atrial fibrillation and intracranial hemorrhage. Journal of Interventional Cardiac Electrophysiology. https://doi.org/10.1007/s10840-019-00678-w