Half-dose DOAC improves outcomes after LAAO
Long-term half-dose direct oral anticoagulation (DOAC) reduces the risk of adverse outcomes after a successful left atrial appendage occlusion (LAAO) with the Watchman device, according to new findings published in JACC: Cardiovascular Interventions.
“The main objective in improving the post-Watchman drug strategy would be to reduce device-related thrombosis and thromboembolic events without increasing the bleeding risk,” wrote lead author Domenico G. Della Rocca, MD, of the Texas Cardiac Arrhythmia Institute at St. David’s Medical Center in Austin, Texas, and colleagues. “Of note, aspirin and clopidogrel were chosen empirically and have not been adequately studied versus alternative approaches. Thus, an active interest in optimizing the antithrombotic regimen after LAA occlusion has emerged because of several clinical concerns with the standard approach.”
Rocca et al. examined data from 555 adult patients who underwent a successful LAAO procedure with the Watchman device at one of three facilities from December 2014 to September 2019. The mean patient age was 75 years old, and 63% of patients were men.
While 198 patients were treated with long-term half-dose DOAC (hdDOAC), the remaining patients received a standard antithrombotic strategy (SAT). The median follow-up period was 13 months.
Overall, hdDOAC was associated with fewer adverse outcomes. Device-related thrombosis was seen in 12 patients, and they were all in the SAT group. The composite outcome of device-related thrombosis, thromboembolic events and major bleeding events was seen in 9.5% of SAT patients, but just 1% of hdDOAC patients.
The group did note that their study was not randomized. Also, because all patients were treated with the Watchman device, these results would not apply to any other devices.
“Future randomized trials assessing the safety and efficacy of different antithrombotic strategies are warranted,” the authors concluded.
Boston Scientific, the manufacturer behind the Watchman device, has had previous relationships with some—but not all—of the study’s co-authors.
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.