Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device
Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device
复制标题
DOI：
10.1016/j.hrthm.2016.10.020
复制
发表时间：
2017-01-01
期刊：
影响因子：
5.5
通讯作者：
Reddy, Vivek Y.
中科院分区：
文献类型：
--
作者：
Enomoto, Yoshinari;Gadiyaram, Varuna K.;Reddy, Vivek Y.
背景 在使用 Watchman 装置（Boston Scientific）进行左心耳封堵的卒中预防试验中，采用了 6 周华法林的植入后抗血栓治疗方案。 目的 鉴于华法林使用的临床复杂性，本研究的目的是研究在 Watchman 植入后围植入期和植入后初期使用非华法林口服抗凝剂（NOAC）代替华法林的相对可行性和安全性。是一项回顾性多中心研究，对象是连续接受 Watchman 植入并接受术中和术后 NOAC 或华法林治疗的患者。植入后 6 周至 4 个月期间进行经食管超声心动图或胸部计算机断层扫描，以评估与装置相关的血栓形成。随访时还评估了出血和血栓栓塞事件。 结果 在 5 个中心，214 名患者以不间断 (82%) 或单次剂量 (16%) 的方式接受 NOAC（46% 阿哌沙班、46% 利伐沙班、7% 达比加群和 1% 依度沙班）。与接受不间断华法林治疗的对照组 (n = 212) 相比，围手术期并发症（包括出血事件）的发生率相似（2.8% vs 2.4%，P = 1）。随访时，NOAC 组和华法林组之间的装置相关血栓形成率（0.9% vs 0.5%，P = 1）、血栓栓塞或装置相关血栓形成率（1.4% vs 0.9%，P = 1）以及术后出血事件（0.5% vs 0.9%，P = .6）也具有可比性。华法林的术后替代方案，用于预防使用 Watchman 装置闭合附件后早期预期的装置相关血栓形成和血栓栓塞并发症，而不增加出血风险。
BACKGROUND 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.OBJECTIVE 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.METHODS 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.RESULTS 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.CONCLUSION 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.