title: New technical and anticoagulation aspects for left atrial appendage closure using the WATCHMAN® device in patients not taking warfarin.
abstract: OBJECTIVE
  The WATCHMAN® device was proven non-inferior to oral anticoagulation (OAT). However, periprocedural risks and uncertainty regarding patients with absolute contraindication for OAT limit the overall utilisation of this approach. We investigated the periprocedural safety of dual platelet inhibition and primary utilisation of larger device diameters in order to minimise peri-device leakage and repositioning of the device during the implantation process.
  
  
  RESULTS
  Since 2010, 59 consecutive patients have been treated with the WATCHMAN® device and followed for six months. In patients with contraindications to warfarin, dual antiplatelet therapy (DAPT) was used during the first 45 days after implantation instead of warfarin. Device size was chosen 15-30% greater than the LAA diameter in order to minimise device repositioning and leakage, and to prevent device embolisation. Small, non-trabecular recesses at the superior ridge towards the inferior, left pulmonary vein were regularly observed and followed by transoesophageal echo regarding thrombus formation. We observed a 3.3% rate of pericardial effusions and a 5% rate of thrombi at the device during the healing period of 45 days and no device embolisations. One thromboembolic event without clinical sequelae was observed during the six-month follow-up period. All patients stopped DAPT at six months as no primary or secondary leakage >5 mm around the device perimeter was observed.
  
  
  CONCLUSIONS
  Our data suggest that DAPT can be used safely during the first 45 days in patients with contraindications to warfarin. An algorithm employing larger devices in relation to the LAA ostium with consecutively larger compression improved procedural safety compared to the current standard regarding leakage and device repositioning.
authors: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors: Felix
authors: F
authors: Meincke
authors: Maximilian
authors: M
authors: Schmidt-Salzmann
authors: Felix
authors: F
authors: Kreidel
authors: Karl-Heinz
authors: KH
authors: Kuck
authors: Martin W
authors: MW
authors: Bergmann
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery*; D004617:Embolism / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin