The WATCHMAN device and post-implantation anticoagulation management. A review of key studies and the risk of device-related thrombosis.

IF 1.3 American journal of cardiovascular disease Pub Date : 2021-12-15 eCollection Date: 2021-01-01
Mohamed Magdi, Sarath Lal Mannumbeth Renjithal, Mahmood Mubasher, Mostafa Reda Mostafa, Yashdeep Lathwal, Pradeeksha Mukuntharaj, Sarah Mohamed, Richard Alweis, Bryan E-Xin Tan, Bipul Baibhav
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Abstract

Background: Ischemic stroke is a devastating complication of atrial fibrillation (Afib). Anticoagulation is the gold standard to prevent stroke and systemic embolization. However, many patients have a contraindication to oral anticoagulation. The WATCHMAN device, which closes the left atrial appendage, is non-inferior to warfarin to prevent embolic events in clinical trials. Post-procedural anticoagulation is needed to avoid device-related thrombosis. The use of anticoagulants after WATCHMAN implantation in patients with high bleeding risks has been a source of debate.

Objective: This article summarizes the current evidence on anticoagulation following the implantation of the WATCHMAN device, focusing on patients who have an absolute contraindication to oral anticoagulation.

Observation: The WATCHMAN device is efficacious and safe in preventing stroke and systemic embolization. Warfarin and aspirin are given for 45 days after implantation. If TEE at 45 days shows minimal residual peri-device flow (≤ 5mm) and no device-related thrombus, warfarin is stopped. This is followed by aspirin and clopidogrel for six months, then aspirin indefinitely. Antithrombotic therapy with aspirin and clopidogrel for six months followed by daily aspirin indefinitely may be feasible for patients with an absolute contraindication to OAC. DOACs are more convenient to use than warfarin, and limited evidence suggests that they are not inferior following implantation of the device.

Conclusion: Following the WATCHMAN implantation, the most often utilized regimen is warfarin followed by antiplatelet treatment. In cases where there is a high risk of bleeding, antiplatelets alone may be sufficient. More research is needed to tailor the existing antithrombotic regimen to the needs of patients.

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WATCHMAN装置与植入后抗凝管理。器械相关血栓形成风险的关键研究综述。
背景:缺血性卒中是心房颤动(Afib)的一种破坏性并发症。抗凝是预防中风和全身栓塞的金标准。然而,许多患者有口服抗凝的禁忌症。WATCHMAN装置关闭左心房附件,在临床试验中防止栓塞事件的效果不低于华法林。术后需要抗凝以避免器械相关血栓形成。高出血风险患者WATCHMAN植入后抗凝剂的使用一直是争论的来源。目的:本文总结了WATCHMAN植入术后抗凝的现有证据,重点介绍了有口服抗凝绝对禁忌症的患者。观察:WATCHMAN装置在预防脑卒中和全身栓塞方面是安全有效的。植入后45天服用华法林和阿司匹林。如果TEE在45天显示最小残余装置周围血流(≤5mm)且无装置相关血栓,则停用华法林。随后服用阿司匹林和氯吡格雷6个月,然后无限期服用阿司匹林。对于有OAC绝对禁忌症的患者,用阿司匹林和氯吡格雷进行6个月的抗血栓治疗,然后无限期地每天服用阿司匹林,可能是可行的。DOACs比华法林更方便使用,有限的证据表明它们在植入装置后并不逊色。结论:WATCHMAN植入后,最常用的方案是华法林加抗血小板治疗。在出血风险高的情况下,单独使用抗血小板可能就足够了。需要更多的研究来调整现有的抗血栓治疗方案以满足患者的需要。
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来源期刊
American journal of cardiovascular disease
American journal of cardiovascular disease CARDIAC & CARDIOVASCULAR SYSTEMS-
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发文量
21
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