DAPT appears safe option after Watchman implantation

Dual antiplatelet therapy for the first 45 days after implantation of the Watchman is safe in patients with contraindications to warfarin, results from the single-center registry have found.

Further, oversizing the device was able to reduce the need for repositioning and device change without an increased risk of pericardial effusions.

In the study, German researchers enrolled 59 consecutive patients who were treated with the Watchman left atrial appendage closure device (Boston Scientific) and followed for 6 months. During the first 45 days after implantation, patients with a contraindication to warfarin were given DAPT instead. Researchers chose a device size 15% to 30% larger than the left atrial appendage diameter, instead of 8% to 20%, as currently suggested by the manufacturer, to minimize device repositioning and leakage and for the prevention of device embolization.

Researchers examined small, non-trabecular recesses at the superior ridge toward the inferior, left pulmonary vein and used transesophageal echocardiography to view thrombus formation. They observed a 3.3% rate of pericardial effusions and a 5% rate of thrombi at the device during the healing period of 45 days, and no device embolizations.

One patient had a thromboembolic event without clinical sequelae during the 6 months. DAPT was stopped at 6 months because no primary or secondary leakage >5 mm around the device was reported.

“DAPT during the first 12 weeks after Watchman implantation demonstrates a similar rate of device-associated thrombus formation compared to warfarin therapy (PROTECT-AF) during this time,” the researchers wrote. “Given the high CHA2DS2-VASc and HAS-BLED scores in our population, the therapy appears safe and effective, even though the registry included only 59 patients.”

Disclosure: The researchers report no relevant financial disclosures.

Published by:

Sources/Disclosures

Collapse

Source: Meincke F. EuroIntervention. 2013;9:463-468.