title: Comparison of Watchman device with new oral anti-coagulants in patients with atrial fibrillation: A network meta-analysis.
abstract: BACKGROUND
  New oral anticoagulants (NOAC) and the Watchman device represent an alternative to warfarin for stroke prophylaxis in atrial fibrillation (AF) patients. However, no studies compare these new treatments. We performed a network meta-analysis to indirectly compare Watchman and NOACs among AF patients.
  
  
  METHODS
  We performed a MEDLINE search for studies comparing warfarin with NOACs (dabigatran, rivaroxaban, apixaban and edoxaban) or Watchman in AF patients with reported clinical outcomes. Mixed treatment comparison model generation was performed to directly and indirectly compare NOACs, warfarin and Watchman.
  
  
  RESULTS
  14 studies with 246,005 patients were included in the analysis, among which 124,823 were treated with warfarin, 120,450 were treated with NOACs and 732 had Watchman implanted. Mean age was 72 ± 9 years, 53% were male, and mean CHADS2 score was 2.1 ± 1.6. Both NOACs and Watchman were superior to warfarin in hemorrhagic stroke prevention (OR = 0.46 [0.30-0.82] and OR = 0.21 [0.05-0.99], respectively). NOACs significantly reduced total stroke (OR = 0.78 [0.58-0.96]) and major bleeding (OR = 0.78 [0.65-0.91]) compared with warfarin. Indirect comparison between NOAC and Watchman revealed no significant differences in outcomes, though there was a trend toward higher rates of ischemic stroke with Watchman compared with NOAC (OR 2.60 [0.60-13.96]) with the opposite findings with hemorrhagic stroke (OR = 0.44 [0.09-2.14]).
  
  
  CONCLUSIONS
  NOAC therapy was superior to warfarin for multiple outcomes while Watchman reduced hemorrhagic stroke. Further studies are needed to assess Watchman versus NOAC to optimize therapy for stroke prevention in AF patients.
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escarcega
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Romain
authors.initials: R
authors.lastname: Didier
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA. Electronic address: Ron.Waksman@Medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002986:Clinical Trials as Topic / Q000379:methods; D000069604:Dabigatran / Q000008:administration & dosage / Q000009:adverse effects; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000592:standards*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects; D013844:Thiazoles / Q000008:administration & dosage / Q000009:adverse effects; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D014859:Warfarin; D000069604:Dabigatran; C552171:edoxaban
keywords: Atrial fibrillation; NOAC; Stroke prophylaxis; Watchman device