Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation Patiens Contraindicated for Oral Anticoagulation. A Single Center Experience.

Background: AF patients at the highest risk for embolic stroke also experience the greatest risk of hemorrhagic complications of anticoagulant use. The PROTECT AF trial revealed that LAA closure using the Watchman device was non inferior to Warfarin for preventing stroke in patients CHADS2 ≥1. However, these patients were treated with Warfarin post-implant until TEE demonstrated LAA closure at 6 weeks. In light of the pressing need for strategies that can prevent stroke in patients with contraindication to anticoagulants, we decided to design our program in anticoagulation-contraindicated patients.

Methods: Since October 2013 till now, we screened for TEE criteria availability 37 patients with CHADS2 ≥2 and contraindication for oral anticoagulants. Here hence, we performed 32 implants in standard fashion. Post-implant, patients were discharged on 6 mo clopidogrel and life-long aspirin. Follow-up TEE was performed at 50 days and 12 months.

Results: 32 patients were successfully implanted. The mean age was 72.5±7.4 years. The prevalence for stroke risk factors was: CHF in 5%, HTN in 85%, Age ≥75 in 75%, DM in 32% and previous stroke/TIA in 65%. The mean CHADS2 score was 2.8±1.2. The contraindication for anticoagulation was hemorrhagic tendency (75%), bleeding (67%), senility with high fall risk (4%) and other (5%). Watchman implantation was successful in 95% of the treated population. At 3.5 years follow-up there were no strokes and one case of device related thrombus by TEE.

Conclusion: Watchman device implantation without an anticoagulant transition seems to be safe and effective in AF patients with contraindications to even short term oral anticoagulation.