Left atrial appendage closure followed by 6 weeks of antithrombotic therapy: A prospective single-center experience

Chun, KR Julian; Bordignon, Stefano; Urban, Verena; Perrotta, Laura; Dugo, Daniela; Fürnkranz, Alexander; Nowak, Bernd; Schmidt, Boris

doi:10.1016/j.hrthm.2013.08.025

Cited by 67 publications

(52 citation statements)

References 19 publications

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“…More importantly, thrombus rate is higher when dual antiplatelet therapy (DAPT) is withdrawn in the first 2 months, and usually falls with the addition of a 2–3-week course of enoxaparin 14 18 19. Nevertheless, information on postimplantation antithrombotic therapy is somewhat contradictory.…”

Section: Discussionmentioning

confidence: 99%

Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure

Mínguez

Asensio

Gragera

et al. 2015

Heart

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AimsThe aim of this study was to observe the percentage of thromboembolic and haemorrhagic events over a 2-year follow-up in patients with non-valvular atrial fibrillation (NVAF) undergoing closure of the left atrial appendage (LAA) with an occlusion device. Observed events and CHADS 2 (congestive heart failure, hypertension, age, diabetes, stroke history), CHA 2 DS 2 -VASc (also adding: vascular disease and sex) and HAS-BLED (hypertension, abnormal liver/renal function, stroke history, bleeding predisposition, labile international normalised ratios, elderly, drugs/alcohol use)-predicted events were compared. Methods LAA closure with an occlusion device was performed in 167 NVAF patients contraindicated for oral anticoagulants and recruited from 12 hospitals between 2009 and 2013. At least two transoesophageal echocardiograms were performed in the first 6 months postimplantation. Antithrombotics included clopidogrel and aspirin. Patients were monitored for death, stroke, major and relevant bleeding and hospitalisation for concomitant conditions. Mean age was 74.68±8.58, median follow-up was 24 months, 5.38% had intraoperative complications and implantation was successful in 94.6% of subjects. Mortality during followup was 10.8%, mostly (9.5%) non-cardiac related. Bleeding occurred in 10.1% of subjects, 5.7% major and 4.4% minor though relevant, and 4.4% suffered stroke. Major bleeding and stroke/transient ischaemic attack events within 2 years (annual event rates, 290 patients/year) were less frequent than expected from CHADS 2 (2.4% vs 9.6%), CHA 2 DS 2 -VASc (2.4% vs 8.3%) and HAS-BLED (3.1% vs 6.6%) risk scores ( p<0.001, p=0.003, p=0.047, respectively). Conclusions LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.

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Section: Discussionmentioning

confidence: 99%

Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure

Mínguez

Asensio

Gragera

et al. 2015

Heart

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show abstract

“…The recommended anticoagulation regimen with the Watchman device is 45 days of warfarin, followed by clopidogrel for at least 6 months. 31 There are no standard recommendations for anticoagulation after the Lariat procedure. Since it is predominantly performed in patients with high bleeding risk, continuation of anticoagulation was not possible in most cases in our study.…”

Section: Differences In Leak Location and Sizementioning

confidence: 99%

Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices: Understanding the differences in the location and type of leaks and their clinical implications

Pillarisetti¹,

Reddy²,

Gunda³

et al. 2015

Heart Rhythm

122

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“…23 Other studies reported high procedure success rates with acceptable procedurerelated complication rates, which is consistent with the present results. 11,13,15, 24 Another interesting finding from the present study was that there were no procedure-related thromboembolic events, although organized LAA thrombi were suspected on TEE in 2 cases. The prevalence of intracardiac thrombi is generally considered a contraindication to intracardiac device manipulation due to concern regarding thromboembolism.…”

Section: Procedural and In-hospital Outcomementioning

confidence: 52%

“…12,22, 24 When comparing the ACP and Watchman devices, immediate post-procedural and follow-up peridevice leakage were more commonly observed for the Watchman device. This may be related to the double disc structure of the ACP, which contributes to better sealing.…”

Section: Peridevice Leakagementioning

confidence: 99%

Left Atrial Appendage Occlusion in Non-Valvular Atrial Fibrillation in a Korean Multi-Center Registry

Kim

Lee

Suh

et al. 2016

Circ J

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Left atrial appendage closure followed by 6 weeks of antithrombotic therapy: A prospective single-center experience

Cited by 67 publications

References 19 publications

Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure

Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure

Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices: Understanding the differences in the location and type of leaks and their clinical implications

Left Atrial Appendage Occlusion in Non-Valvular Atrial Fibrillation in a Korean Multi-Center Registry

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