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.