P4818Role of new oral anticoagulants in left atrial occluder device implants

Abstract

Background: The safety and efficacy of left atrial appendage occluder device using Warfarin during the initial 45 days period is well established. The value of new oral anticoagulants (NOACs) in place of warfarin has not been reported previously. Objective:We sought to evaluate the safety and efficacy outcomes of the NOACs post Watchman device implantation as compare to standard warfarin therapy. Methodology: Patients with atrial fibrillation and CHA2DS2VASc score of at least 2 were screened for suitability of Watchman implant. Patients were divided into a standard per protocol Warfarin therapy and the new oral anticoagulation (dabigatran, apixaban, or xarelto) groups after the implants. Their safety and efficacy outcomes were analyzed at each follow-up period of 45 days, 180 days and 360 days respectively. Results: 93 consecutive patients had successful implantation of the LAA occluder device. 52 (55.9%) patients received Warfarin and 41 (44.1%) received NOACs immediately post procedure. Comparing the warfarin versus NOAC group, the mean age was 65.7+11.4 years in both groups, ejection fraction was 57.5 + 9.7% vs 53.2 + 14.6%, female sex was (50% vs 68.3%, p 0.051) and 1.9% vs 7.3% (p 0.203) had prior stroke respectively. Majority of patients were implanted a size 24 or 27mm device (73.1% vs 48.8%, p 0.016). There was a 1.9% reported case of pericardial effusion in warfarin vs none in NOAC (p 0.366). At 45 days follow up, there was 1 (1.1%) case of device related thrombus in each group. One patient in NOAC group (1.1%) had a 6mm peri-device leak as compare to none in warfarin group. No cases of cerebrovascular events reported at 6 months and 1 year follow-up. Total of 95.7% vs 81.6% (p 0.035), 97.4% vs 94.1% (p 0.491), and 100% vs 91.3% (p 0.085) of patients were able to come off oral anticoagulants at 45days, 140 days and 365 days respectively. At 12 + 3 months follow-up there were 3 (2.97%) and 4 (3.97%) cardiovascular related deaths in Warfarin and NOACs group. Conclusion: This is the largest single center registry data for Watchman implant in the Asia Pacific region. The use of new oral anticoagulants within the first 45 days post watchman implant results in comparatively similar safety and efficacy benefit as compare to per-protocol warfarin therapy.