Premium
Propensity‐matched comparison of antiplatelet versus anticoagulant after left atrial appendage closure with the Watchman
Author(s) -
Liu XiaoXia,
Kleinecke Caroline,
Busch Sonia,
Allakkis Wasim,
Mohrez Yamen,
CheikhIbrahim Mohammad,
Mahnkopf Christian,
Brachmann Johannes,
Schnupp Steffen,
Gloekler Steffen,
Yu Jiangtao,
Ma Changsheng
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14032
Subject(s) - medicine , hazard ratio , propensity score matching , clinical endpoint , confidence interval , aspirin , cardiology , antithrombotic , surgery , randomized controlled trial
Background Optimal antithrombotic therapy following left atrial appendage closure (LAAC) with the Watchman occluder remains uncertain. This study retrospectively compared clinical outcomes of a 3‐month dual antiplatelet therapy (DAPT group) and a protocol of anticoagulation plus aspirin for 45 days followed by DAPT for 6 months (ACT group) after LAAC with the Watchman device. Methods Of two Watchman registries (Coburg and Lichtenfels hospitals, Germany), 220 and 304 consecutive patients with successful LAAC were included. Patients in Coburg hospital received DAPT while they received ACT in Lichtenfels. After a 1:1 propensity score matching, 174 (DAPT) versus 174 (ACT) patients were compared by use of the primary efficacy endpoint of thromboembolic events and cardiovascular/unexplained death, the primary safety endpoint of nonprocedural related major bleeding events at follow‐up, and the combined hazard endpoint, a composite of all above‐mentioned hazards. Results The mean age 77.5 ± 7.2 (DAPT) versus 77.3 ± 7.1 (ACT) years, CHA 2 DS 2 ‐VASc score 4.6 ± 1.5 versus 4.7 ± 1.6, and HAS‐BLED score 3.3 ± 0.8 versus 3.3 ± 0.8 were similar. After 12 months, the clinical efficacy (13/174, 7.4% [DAPT] vs 11/174, 6.3% [ACT]; hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.38‐1.86; P = .66) and safety (6/174, 3.4% vs 8/174, 4.5%; HR, 0.86; 95% CI, 0.29‐2.56; P = .79) as well as the combined hazard endpoint (18/174, 10.3% vs 18/174, 10.3%; HR,1.01; 95% CI, 0.53‐1.95; P = .97) were comparable. Conclusions This study suggests comparable efficacy and safety of 3‐month DAPT versus 6 weeks ACT plus aspirin following LAAC with the Watchman.