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VIDEO: Debate continues over LAA closure benefits by bleeding risks
SAN FRANCISCO — Matthew J. Price, MD, an interventional cardiologist at Scripps Clinic, La Jolla, California, recaps a “vigorous debate” at the annual TCT Scientific Symposium over left atrial appendage closure with a device in patients with nonvalvular atrial fibrillation at low risk for bleeding.
“One of the potential advantages of the Watchman (Boston Scientific) device is to mitigate the risk of stroke and thromboembolism … without having to take an oral anticoagulant, thereby reducing the risk of bleeding,” Price said. “What about the patient who isn’t at high risk for bleeding to begin with?”
Price reviews key differences in device implantation guidelines between Europe and the United States, detailing the populations approved and rationales — including data from the PROTECT AF and PREVAIL trials.
He offers a glimpse of soon-to-be-published results from a pooled analysis of randomized trials investigating bleeding with warfarin vs. left atrial appendage (LAA) closure, highlighting “provocative and interesting” outcomes in absolute bleeding reductions among subgroups.
“Time will tell, as the Watchman device gets more acceptance in the United States, how clinicians decide to use it according to the FDA label,” Price said.