Sarver Heart Center, University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ, 85724-5037, USA.
J Interv Card Electrophysiol. 2022 Jun;64(1):1-8. doi: 10.1007/s10840-021-00958-4. Epub 2021 Feb 12.
Patients with atrial fibrillation are increasingly prescribed a direct oral anticoagulant (DOAC) over warfarin and seek to avoid anticoagulation even without a history of major bleeding. This study explores the outcomes of patients implanted with a Watchman device in relation to anticoagulation choice (warfarin versus DOAC) in the post-procedure period and a history of bleeding.
Patients implanted with a Watchman device at a single center were retrospectively analyzed. Characteristics including anticoagulation in the first 45 days and history of major bleed were assessed and efficacy (thromboembolism) and safety (bleeding) outcomes compared by Kaplan-Meier analysis.
Two hundred nine patients were implanted (57% male, age 74.6 ± 7.8 years) and followed for 23.5 ± 7.1 months. In the first half of patients, 98% were prescribed warfarin, which dropped to 51% in the second half (p < 0.0001). A history of major bleed was present in 80.8% of the first half of patients and decreased to 60% in the second half (p = 0.001). There were 16 safety and 4 efficacy events. There was no difference in safety outcomes according to history of major bleeding or anticoagulant choice in the first 45 days. There was no difference in efficacy outcomes over the duration of follow-up according to anticoagulation choice in the first 45 days.
Patients implanted with a Watchman device were increasingly over time prescribed a DOAC and implanted without a history of major bleeding. Bleeding and thromboembolic events were infrequent and related neither to choice of anticoagulant nor to prior major bleeding.
患有心房颤动的患者越来越多地被开处直接口服抗凝剂（DOAC）而非华法林，并寻求避免抗凝治疗，即使他们没有大出血史。本研究探讨了在术后期间及有出血史的情况下，患者接受 Watchman 装置植入与抗凝药物选择（华法林与 DOAC）之间的关系。
对一家中心的 Watchman 装置植入患者进行回顾性分析。评估包括术后 45 天内的抗凝治疗情况和主要出血史，并采用 Kaplan-Meier 分析比较疗效（血栓栓塞）和安全性（出血）结果。
共植入 209 例患者（57%为男性，年龄 74.6±7.8 岁），随访 23.5±7.1 个月。在前半段患者中，98%的患者被开处华法林，而后半段降至 51%（p＜0.0001）。在前半段患者中，有 80.8%的患者有大出血史，而后半段降至 60%（p=0.001）。有 16 例安全性事件和 4 例有效性事件。在前 45 天内，根据大出血史或抗凝药物选择，安全性结果没有差异。在前 45 天内根据抗凝药物选择，在随访期间的疗效结果没有差异。
随着时间的推移，接受 Watchman 装置植入的患者越来越多地被开处 DOAC，且无大出血史。出血和血栓栓塞事件罕见，与抗凝药物选择或既往大出血史无关。
