{"id":11244,"date":"2011-08-29T13:26:08","date_gmt":"2011-08-29T17:26:08","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&#038;p=11244"},"modified":"2011-08-29T13:26:08","modified_gmt":"2011-08-29T17:26:08","slug":"esc-a-closure-device-and-a-warfarin-substitute-for-high-risk-afib-patients","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/08\/29\/esc-a-closure-device-and-a-warfarin-substitute-for-high-risk-afib-patients\/","title":{"rendered":"ESC: A Closure Device and a Warfarin Substitute for High-Risk AFib Patients"},"content":{"rendered":"<p>How can we manage a patient with atrial fibrillation and contraindications to warfarin therapy such as recurrent severe bleeding \u2014 a common scenario in clinical practice? Data from the manufacturer-sponsored <a href=\"http:\/\/clinicaltrials.gov\/show\/NCT00851578\">ASAP study<\/a> (ASA Plavix Feasibility Study with WATCHMAN Left Atrial Appendage Closure Technology)<strong> <\/strong>provides some hope, beyond what we had learned from the <a href=\"http:\/\/clinicaltrials.gov\/ct\/show\/NCT00129545\">Protect AF trial<\/a>. Annkathrin Braut, of the Frankfurt Cardiovascular Center, presented preliminary results from ASAP.<\/p>\n<p>This feasibility study of Watchman device implantation enrolled 125 high-risk atrial fibrillation patients from the Czech Republic and Germany. All had contraindications to warfarin, so instead they were given clopidogrel (for 6 months) and aspirin (planned as lifelong therapy). The average CHADS2 score was 2.7.<\/p>\n<p>Of the enrollees, 93% had successful device implantation. Complications to date have included 1 episode of cardiac tamponade, 2 episodes of device embolization requiring retrieval, and 1 femoral artery pseudoaneurysm. During about 10 months of follow-up, 4 episodes of device-related thrombus (requiring heparin therapy) occurred, and 3 patients developed ischemic stroke.<\/p>\n<p>The investigators suggest that Watchman device implantation without warfarin overlap is a safe, feasible strategy and that LAA closure is a viable alternative in high-risk atrial fibrillation patients who have contraindications to warfarin.<\/p>\n<p>The ESC audience in Paris raised two main concerns: (1) about giving aspirin and clopidogrel to patients already known to have had a high incidence of bleeding with warfarin; and (2) about the occurrence of 3 ischemic strokes in this relatively small cohort.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>How can we manage a patient with atrial fibrillation and contraindications to warfarin therapy such as recurrent severe bleeding \u2014 a common scenario in clinical practice? Data from the manufacturer-sponsored ASAP study (ASA Plavix Feasibility Study with WATCHMAN Left Atrial Appendage Closure Technology) provides some hope, beyond what we had learned from the Protect AF [&hellip;]<\/p>\n","protected":false},"author":358,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[495],"tags":[364,341,334,326,368],"class_list":["post-11244","post","type-post","status-publish","format-standard","hentry","category-anticoagulation-2","tag-aspirin","tag-atrial-fibrillation","tag-clopidogrel","tag-esc","tag-warfarin"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/11244","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/358"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=11244"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/11244\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=11244"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=11244"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=11244"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}