title: Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors: Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Yoshinari
authors: Y
authors: Enomoto
authors: Interventional Electrophysiology, Scripps Clinic, La Jolla, California.
authors: Varuna K
authors: VK
authors: Gadiyaram
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors: Carola
authors: C
authors: Gianni
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas.
authors: Rodney P
authors: RP
authors: Horton
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors: Chintan
authors: C
authors: Trivedi
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Dell Medical School, University of Texas, Austin, Texas.
authors: Sanghamitra
authors: S
authors: Mohanty
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
authors: Luigi
authors: L
authors: Di Biase
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors: Amin
authors: A
authors: Al-Ahmad
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors: J David
authors: JD
authors: Burkhardt
authors: Interventional Electrophysiology, Scripps Clinic, La Jolla, California.
authors: Arvin
authors: A
authors: Narula
authors: Interventional Electrophysiology, Scripps Clinic, La Jolla, California.
authors: Gwen
authors: G
authors: Janczyk
authors: Interventional Electrophysiology, Scripps Clinic, La Jolla, California.
authors: Matthew J
authors: MJ
authors: Price
authors: Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas.
authors: Muhammad R
authors: MR
authors: Afzal
authors: Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas.
authors: Moustapha
authors: M
authors: Atoui
authors: Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas.
authors: Matthew
authors: M
authors: Earnest
authors: Arizona Heart Rhythm Center, Phoenix, Arizona.
authors: Vijay
authors: V
authors: Swarup
authors: Pacific Heart Institute, Providence St. Johns Health Center, Santa Monica, California.
authors: Shephal K
authors: SK
authors: Doshi
authors: Pacific Heart Institute, Providence St. Johns Health Center, Santa Monica, California.
authors: Sarina
authors: S
authors: van der Zee
authors: Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Rebecca
authors: R
authors: Fisher
authors: Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas.
authors: Dhanunjaya R
authors: DR
authors: Lakkireddy
authors: Interventional Electrophysiology, Scripps Clinic, La Jolla, California.
authors: Douglas N
authors: DN
authors: Gibson
authors: Interventional Electrophysiology, Scripps Clinic, La Jolla, California; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Dell Medical School, University of Texas, Austin, Texas; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Cardiology, Stanford University, Stanford, California,; Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, California.
authors: Andrea
authors: A
authors: Natale
authors: Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: vivek.reddy@mountsinai.org.
authors: Vivek Y
authors: VY
authors: Reddy
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000494:pharmacology; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000601:surgery*; D001281:Atrial Fibrillation / Q000517:prevention & control; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Device-related thrombosis; Left atrial appendage; Non-warfarin oral anticoagulants; Stroke; Thromboembolism; Watchman