Left Atrial Appendage Closure With the Watchman Device in Patients With a Contraindication for Oral Anticoagulation: The ASAP Study (ASA Plavix Feasibility Study With Watchman?Left?Atrial Appendage Closure Technology)

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• 作者：Vivek Y. Reddy ; MD^&lowast ; ; ^{vivek.reddy@mountsinai.org} ; Sven Mö ; bius-Winkler ; MD^&dagger ; ; Marc A. Miller ; MD^&lowast ; ; Petr Neuzil ; MD ; PhD^&Dagger ; ; Gerhard Schuler ; MD^&dagger ; ; Jens Wiebe ; MD^§ ; ; Peter Sick ; MD^? ; Horst Sievert ; MD^§ ;
• 关键词：atrial fibrillation ; left atrial appendage closure ; stroke
• 刊名：Journal of the American College of Cardiology
• 出版年：2013
• 出版时间：25 June, 2013
• 年：2013
• 卷：61
• 期：25
• 页码：2551-2556
• 全文大小：227 K

文摘

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Objectives

The purpose of this study was to assess the safety and efficacy of left atrial appendage (LAA) closure in nonvalvular atrial fibrillation (AF) patients ineligible for warfarin therapy.

Background

The PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that LAA closure with the Watchman device (Boston Scientific, Natick, Massachusetts) was noninferior to warfarin therapy. However, the PROTECT AF trial only included patients who were candidates for warfarin, and even patients randomly assigned to the LAA closure arm received concomitant warfarin for 6 weeks after Watchman implantation.

Methods

A multicenter, prospective, nonrandomized study was conducted of LAA closure with the Watchman device in 150?patients with nonvalvular AF and CHADS₂ (congestive heart failure, hypertension, age?¡Ý75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score?¡Ý1, who were considered ineligible for warfarin. The primary efficacy endpoint was the combined events of ischemic stroke, hemorrhagic stroke, systemic embolism, and cardiovascular/unexplained death.

Results

The mean CHADS₂ score and CHA₂DS₂-VASc (CHADS₂ score plus 2 points for age?¡Ý75 years and 1 point for vascular disease, age 65 to 74 years, or female sex) score were 2.8 ¡À 1.2 and 4.4 ¡À 1.7, respectively. History of hemorrhagic/bleeding tendencies (93 % ) was the most common reason for warfarin ineligibility. Mean duration of follow-up was 14.4 ¡À 8.6 months. Serious procedure- or device-related safety events occurred in 8.7 % of patients (13 of 150 patients). All-cause stroke or systemic embolism occurred in 4 patients (2.3 % per year): ischemic stroke in 3 patients (1.7 % per year) and hemorrhagic stroke in 1 patient (0.6 % per year). This ischemic stroke rate was less than that expected (7.3 % per year) based on the CHADS₂ scores of the patient cohort.

Conclusions

LAA closure with the Watchman device can be safely performed without a warfarin transition, and is a reasonable alternative to consider for patients at high risk for stroke but with contraindications to systemic oral anticoagulation. (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology [ASAP]; )