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      Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry

      a , * , 1 , b , c , d , e , f , g , h , h , i

      International Journal of Cardiology. Heart & Vasculature

      Elsevier

      BMI, body mass index, CI, confidence interval, LAA, left atrial appendage, NOAC, Novel oral anticoagulant, NVAF, non-valvular atrial fibrillation, OAC, oral anticoagulation, SAE, serious adverse events, SE, systemic embolism, TOE, transoesophageal echocardiography, TIA, transient ischaemic attack, WASP, The Asia-Pacific Registry on WATCHMAN Outcomes in Real-Life Utilization, Atrial fibrillation, Ischaemic stroke, Left atrial appendage, LAA device closure, Anticoagulant therapy

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          Abstract

          Background

          Left atrial appendage closure is a non-pharmacological alternative for stroke prevention in high-risk non-valvular atrial fibrillation patients, but has not been widely studied in Asian patients. The prospective WASP registry assessed real-world outcomes for patients undergoing WATCHMAN implant in the Asia-Pacific region.

          Methods

          Data were collected from consecutive patients across 9 centres. Major endpoints included procedural success, safety and long-term outcomes including occurrence of bleeding, stroke/transient ischaemic attack/systemic embolism and all-cause mortality.

          Results

          Subjects ( n = 201) had a mean age of 70.8 ± 9.4 years, high stroke risk (CHA 2DS 2-VASc: 3.9 ± 1.7), elevated bleeding risk (HAS-BLED: 2.1 ± 1.2) with 53% patients from Asian countries. Successful implantation occurred in 98.5% of patients; 7-day device/procedure-related SAE rate was 3.0%. After 2 years of follow-up, the rates of ischaemic stroke/TIA/SE and major bleeding were 1.9 and 2.2 per 100-PY, respectively, representing relative reductions of 77% and 49% versus expected rates per risk scores. The relative risk reductions versus expected rates were more pronounced in Asians vs. Non-Asians (89% vs 62%; 77% vs 14%). Other significant findings included larger mean LAA ostium diameter for Asians vs. Non-Asians (23.4 ± 4.1 mm vs. 21.2 ± 3.2 mm, p < 0.001) and hence requirement for larger median device size (27 mm for Asians, 24 mm for non-Asians [ p < 0.0001]).

          Conclusion

          Real-world experience of left atrial appendage closure with WATCHMAN has demonstrated low peri-procedural risk, and long-term efficacy for stroke and bleeding prevention in a primarily Asian cohort.

          Graphical abstract

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          Most cited references 14

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          Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: A Patient-Level Meta-Analysis.

          The risk-benefit ratio of left atrial appendage closure (LAAC) versus systemic therapy (warfarin) for prevention of stroke, systemic embolism, and cardiovascular death in nonvalvular atrial fibrillation (NVAF) requires continued evaluation.
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            Efficacy and safety of left atrial appendage closure with WATCHMAN in patients with or without contraindication to oral anticoagulation: 1-Year follow-up outcome data of the EWOLUTION trial.

            Left atrial appendage (LAA) occlusion with WATCHMAN has emerged as viable alternative to vitamin K antagonists in randomized controlled trials.
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              • Article: not found

              Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation

              Supplemental Digital Content is available in the text.
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                Author and article information

                Contributors
                Journal
                Int J Cardiol Heart Vasc
                Int J Cardiol Heart Vasc
                International Journal of Cardiology. Heart & Vasculature
                Elsevier
                2352-9067
                09 April 2019
                June 2019
                09 April 2019
                : 23
                Affiliations
                [a ]HeartCare Partners, GenesisCare, Brisbane, Australia
                [b ]Medistra Hospital, Jakarta, Indonesia
                [c ]South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
                [d ]MonashHEART, Monash Health, Melbourne, Australia
                [e ]Queen Elizabeth Hospital, Hong Kong
                [f ]Yonsei University Health System, Seoul, Republic of Korea
                [g ]Ramathibodi Hospital, Bangkok, Thailand
                [h ]Boston Scientific Corp., Minneapolis, MN, USA
                [i ]National Heart Institute, Kuala Lumpur, Malaysia
                Author notes
                [* ]Corresponding author at: Suite 212, Ramsay Specialist Centre, Greenslopes Private Hospital, Newdegate Street, Brisbane 4120, Australia. Karen.Phillips@ 123456genesiscare.com
                [1]

                This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

                Article
                S2352-9067(19)30027-2 100358
                10.1016/j.ijcha.2019.100358
                6458488
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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