loading page

1-Year Outcomes of 3-Month Dual Antiplatelet Therapy after Left Atrial Appendage Closure with the Watchman Occluder (the DUAL-WATCH study): a Post Hoc Analysis
  • +7
  • Xiaoxia Liu,
  • Caroline Kleinecke,
  • Sonia Busch,
  • Wasim Allakkis,
  • Christian Mahnkopf,
  • Johannes Brachmann,
  • Steffen Schnupp,
  • Steffen Gloekler,
  • Jiangtao Yu,
  • Chang Sheng Ma
Xiaoxia Liu
Beijing Anzhen Hospital, Capital Medical University
Author Profile
Caroline Kleinecke
Helmut-G.-Walther-Klinikum
Author Profile
Sonia Busch
Klinikum Coburg
Author Profile
Wasim Allakkis
Klinikum Coburg
Author Profile
Christian Mahnkopf
Klinikum Coburg
Author Profile
Johannes Brachmann
Klinikum Coburg
Author Profile
Steffen Schnupp
Klinikum Coburg
Author Profile
Steffen Gloekler
University Hospital of Bern
Author Profile
Jiangtao Yu
Helmut-G.-Walther-Klinikum
Author Profile
Chang Sheng Ma
Beijing Anzhen Hospital, Capital Medical University
Author Profile

Abstract

Objective: Optimal antithrombotic therapy following left atrial appendage closure (LAAC) with the Watchman occluder (Boston Scientific) remains uncertain. This study aimed to investigate the efficacy and safety of a 3-month dual antiplatelet therapy (DAPT) after LAAC. Methods: This was a post hoc analysis of a prospective study of patients who underwent successful LAAC with Watchman devices at the REGIOMED Hospitals of Coburg and Lichtenfels (Germany). Those treated from 11/2016 to 05/2018 received DAPT for 3 months (DAPT group); those from 02/2012 to 04/2017 received 45-day anticoagulant+aspirin followed by 4.5-month DAPT (ACT group). The primary efficacy outcome and safety outcome were analyzed. The net clinical benefit and bleeding events 1 year after treatment, and their independent risk factors were also explored. Results: There were 220 and 304 patients in the DAPT and ACT groups. The primary efficacy outcome were 9.5% vs. 6.3% [hazard ratio (HR), 1.58; 95% confidence interval (CI), 0.84-2.97; P=0.14]; the primary safety outcome were 4.5% vs. 5.9% (HR, 0.80; 95% CI, 0.38-1.69; P=0.57); the net clinical benefit were 13.6% vs. 11.8% (HR, 1.23; 95% CI, 0.75-2.02; P=0.39) over 1 year in DAPT and ACT groups, respectively. Age ≥75 years (HR, 2.08; 95%CI, 1.13-3.84; P=0.02) was identified as an independent predictor for the net clinical benefit. ACT (HR, 1.97; 95%CI, 1.12-3.50; P=0.02) was independently associated with bleeding events after procedure. Conclusions: In patients who underwent LAAC using the Watchman occluder, 3-month DAPT is associated with fewer bleeding events compared with ACT regimen.