Left Atrial Appendage Closure in Patients With Contraindications to Oral Anticoagulation

The PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) and PREVAIL (Prospective Randomized Evaluation of the Watchman LAA Closure Device In Patients With Atrial Fibrillation Versus Long-Term Warfarin Therapy) trials revealed that in atrial fibrillation (AF) patients suitable for oral anticoagulation (OAC), mechanical left atrial appendage closure (LAAC) with a catheter-delivered heart implant device (Watchman; Boston Scientific, Marlborough, Massachusetts) is effective for stroke prevention (1,2). Importantly, these patients received at least 6 weeks of OAC. Although there is no randomized LAAC trial in OAC-contraindicated patients, there is 1 prospective nonrandomized study of Watchman in these patients (n = 150; CHA2DS2-VASc [Congestive heart failure; Hypertension; Age; Diabetes mellitus; prior Stroke, TIA, or thromboembolism; Vascular disease; Age; Sex category {female}] score = 4.4) (3). In this trial, ASAP (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology), the post-implantation annual ischemic stroke rate was 1.7%, representing 77% fewer strokes than expected for this population. Although promising, the mean follow-up in ASAP was only 1.2 years, so there have been few long-term data regarding LAAC in OAC-contraindicated patients. Herein, we report the 5-year follow-up of ASAP.
Source: Journal of the American College of Cardiology - Category: Cardiology Source Type: research