title: Retrospective Cohort Study Examining Reduced Intensity and Duration of Anticoagulant and Antiplatelet Therapy Following Left Atrial Appendage Occlusion with the WATCHMAN Device.
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 >4mm 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 >4mm 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).
  
  
  CONCLUSIONS
  Following WATCHMAN implant shortened periods of anticoagulants and antiplatelets may be considered, particularly in the context of high bleeding risk.
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; Monash Health, Melbourne, Vic, Australia. Electronic address: mattytung@gmail.com.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Tung
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; Monash Health, Melbourne, Vic, Australia.
authors.forename: Satish
authors.initials: S
authors.lastname: Ramkumar
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; Monash Health, Melbourne, Vic, Australia.
authors.forename: James D
authors.initials: JD
authors.lastname: Cameron
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; Monash Health, Melbourne, Vic, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pang
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; Monash Health, Melbourne, Vic, Australia.
authors.forename: Nitesh
authors.initials: N
authors.lastname: Nerlekar
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; Monash Health, Melbourne, Vic, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Kotschet
authors.affiliation: Monash Cardiovascular Research Centre, Monash University, Melbourne, Vic, Australia; Monash Health, Melbourne, Vic, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Alison
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000601:surgery*; D004617:Embolism / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Anticoagulation; Antiplatelet; Atrial fibrillation; Left atrial appendage occlusion; Stroke; WATCHMAN