LAAC, antithrombotic therapy, and TEE
The characteristics of the Watchman device (Boston Scientific,
Marlborough, MA, US) and procedural aspects were previously described in
detail 17. The device was implanted via a transseptal
approach using a delivery sheath. All procedures were guided by
transesophageal echocardiography (TEE) and fluoroscopy.
At the Lichtenfels site, patient enrollment started in 2012.
Antithrombotic therapy following LAAC was performed according to the
PROTECT-AF trial 10 and consisted of 45 days of
aspirin plus OAC with a VKA or a NOAC (ACT group). Since the majority of
the patients had contraindications to OAC, a fully dosed low molecular
weight heparin was administered instead. In case of complete LAA closure
without 45-day DRT or major (≥5 mm) peri-device leak, anticoagulation
was stopped, and clopidogrel and aspirin were given until the final
6-month TEE control. In case of an unremarkable result, aspirin was
continued indefinitely as a single antiplatelet therapy.
At the Coburg site, patient recruitment started in 2016, and the
postprocedural antithrombotic regimen consisted of a short DAPT with
aspirin and clopidogrel for 3 months only (DAPT group). In this group, a
single follow-up TEE was performed after 3 months. In the case of DRT,
the antithrombotic therapy was switched to OAC.