Retrospective Cohort Study Examining Reduced Intensity and Duration of Anticoagulant and Antiplatelet Therapy Following Left Atrial Appendage Occlusion with the WATCHMAN Device

Matthew K. Tung, Satish Ramkumar, James D. Cameron, Benjamin J Pang, Nitesh Nerlekar, Emily Kotschet, Jeffrey Alison

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5 Citations (Scopus)

Abstract

Background Anticoagulant and antiplatelet therapy are recommended following WATCHMAN implantation (45 days and 6 months) to reduce the risk of embolic events. These patients are often also at high risk of recurrent bleeding complications. We aimed to assess the safety of reduced duration of treatment with anticoagulant and antiplatelet therapy in the early post implant period. Methods This was a retrospective cohort study assessing the duration of antiplatelet and anticoagulant therapy in 47 consecutive patients following WATCHMAN implant. The primary outcome was rate of major bleeding, stroke and systemic embolic complications. The secondary endpoints were rate of device thrombus and peri-device leak >4 mm as assessed by transoesophogeal echocardiography. Results Forty-seven patients were followed up for a mean of 2.4+/-1.7 years (111.4 total patient-years). The rate of stroke was 1.8/100 patient-years (two events) and the rate of major bleeding complication was 8.9/100 patient-years. Three patients had peri-device leak >4 mm and no patients had device thrombus visualised. 70.2% of patients had discontinued anticoagulation at 45 days, 89.4% had discontinued dual antiplatelet therapy at 90 days. Seven patients were not on any form of anticoagulant or antiplatelet at five months. Comparison of probability of survival free from stroke by time of cessation of anticoagulant and antiplatelet therapy demonstrated no significant differences (p-value for log rank test 0.238 and 0.820). Conclusion Following WATCHMAN implant shortened periods of anticoagulants and antiplatelets may be considered, particularly in the context of high bleeding risk.

Original languageEnglish
Pages (from-to)477-485
Number of pages9
JournalHeart Lung and Circulation
Volume26
Issue number5
DOIs
Publication statusPublished - 1 May 2017

Keywords

  • Anticoagulation
  • Antiplatelet
  • Atrial fibrillation
  • Left atrial appendage occlusion
  • Stroke
  • WATCHMAN

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