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2022 AF Symposium
Procedural Anticoagulation with LAA Closure Devices―An Evolving A-Fib Story
Luigi Di Biase MD
Dr. Luigi Di Biase of the Albert Einstein College of Medicine, Bronx, NY gave a presentation on “Peri and Post Procedural Anticoagulation with LAA Closure Devices―An Evolving Story”
Watchman Device Anticoagulation Protocol
The Watchman occlusion device to close off the Left Atrial Appendage (LAA) of Atrial Fibrillation patients was FDA approved in 2015 (PROTECT AF and PREVAIL clinical studies).
Dr. Di Biase explained how the standard anticoagulation protocol to prevent stroke after implementation was warfarin for 45 days followed by Dual Antiplatelet Therapy (DAPT) for six months. (DAPT combines aspirin with clopidogrel.) Then the patient was on aspirin for life.
NOACs (DOACs) Have Replaced Warfarin
In common practice today, NOACs (DOACs) (Direct Oral Anticoagulants) have replaced warfarin post-op. However, there are concerns about the DAPT protocol.
Dr. Di Biase gave the example of a patient who experienced a GI bleed 2 months after switching from a NOAC to the DAPT protocol (clopidogrel/aspirin). DAPT therapy may carry bleeding risks while providing sub-optimal stroke prevention. Genetic abnormalities may affect the efficacy of clopidogrel in as many as 25% of patients.
DRT (Device Related Thrombus) can occur in 3%-4% of cases. “In our opinion, DRT is more common with DAPT when compared to low dose NOAC.”
Low Dose NOAC Possibly Safer Than Aspirin For Life
He also pointed out that “in some cases, we feel low dose NOAC is safer than aspirin for life.”
Editor’s Comments
What does this means for patients receiving the Watchman? Instead of switching to clopidogrel/aspirin after 45 days post-op, we can stay on uninterrupted NOAC but at low dose with lower risk of bleeding and better results.
This makes the installation of the Watchman device safer and more effective (it was remarkably effective before this).
If you find any errors on this page, email us. Y Last updated: Wednesday, February 23, 2022
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