Gu Zhi-Chun, Qiao Zhi-Qing, Hao Zi-Yong, Li Zheng, Jiang Li-Sheng, Ge Heng, He Ben, Pu Jun
Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Ann Transl Med. 2020 Feb;8(4):105. doi: 10.21037/atm.2019.12.116.
Warfarin is now recommended as the standard anti-thrombotic regimen to allow complete endothelialization over the Watchman device post percutaneous left atrial appendage occlusion (LAAO). However, the need for frequent monitoring, narrow therapeutic range, dietary restrictions and multiple drug interactions associated with warfarin have contributed to increasing uptake of non-vitamin K oral anticoagulants (NOACs) worldwide. At present, the feasibility and safety of NOACs instead of warfarin post-LAAO is lacking.
Patients who underwent successful Watchman device implantation between October 1, 2016 and September 30, 2017 were enrolled in a retrospective database. And only patients who received rivaroxaban in the periprocedural period were included in this study. Transesophageal echocardiography (TEE) follow-up was scheduled at 6 weeks, at 6 months, and at 12 months post-implantation to detect device-related thrombosis (DRT) or peri-device leak. Meanwhile, thromboembolic and bleeding events were also evaluated at the time of follow-up.
Totally, 57 Watchman devices were successfully implanted and 10 patients who were allocated to rivaroxaban at the dosage of 20 mg once daily were included. During the follow-up, none of the patients using rivaroxaban experienced DRT, peri-device leak, thromboembolic complications and major bleeding events, except for 2 patients who suffered minor bleeding during the 6 weeks follow-up.
This study suggests that a short course of standard-dose rivaroxaban following Watchman LAAO is associated with low incidence of thrombotic complications and bleeding events, and might be a feasible alternative regimen in Chinese. Further randomized trials and large sample of real-world studies are needed to validate our finding.
目前，华法林被推荐作为标准的抗栓治疗方案，以使经皮左心耳封堵术（LAAO）后在Watchman装置上实现完全内皮化。然而，华法林需要频繁监测、治疗窗窄、饮食限制以及存在多种药物相互作用，这导致全球非维生素K口服抗凝药（NOACs）的使用量不断增加。目前，LAAO术后使用NOACs替代华法林的可行性和安全性尚不明确。
将2016年10月1日至2017年9月30日期间成功植入Watchman装置的患者纳入回顾性数据库。本研究仅纳入围手术期接受利伐沙班治疗的患者。在植入后6周、6个月和12个月安排经食管超声心动图（TEE）随访，以检测与装置相关的血栓形成（DRT）或装置周围渗漏。同时，在随访时评估血栓栓塞和出血事件。
共成功植入57个Watchman装置，纳入10例每日一次服用20 mg利伐沙班的患者。随访期间，除2例患者在6周随访时出现轻微出血外，使用利伐沙班的患者均未发生DRT、装置周围渗漏、血栓栓塞并发症和严重出血事件。
本研究表明，Watchman LAAO术后短期使用标准剂量利伐沙班与血栓并发症和出血事件的低发生率相关，在中国可能是一种可行的替代方案。需要进一步的随机试验和大量真实世界研究来验证我们的发现。
