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Updated: Dec 12, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Propensity-matched comparison of antiplatelet versus anticoagulant after left atrial appendage closure with the
Xiao-Xia Liu1, Caroline Kleinecke2, Sonia Busch3
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China.
Insights
Optimal antithrombotic therapy after Watchman left atrial appendage closure (LAAC) showed similar efficacy and safety for both 3-month dual antiplatelet therapy (DAPT) and a shorter anticoagulation plus aspirin regimen. Both strategies effectively managed thromboembolic events and bleeding risks post-LAAC.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Research
Background:
- Left atrial appendage closure (LAAC) with the Watchman device is an alternative to anticoagulation for stroke prevention in atrial fibrillation.
- Optimal antithrombotic therapy post-LAAC remains an area of clinical uncertainty.
- Existing guidelines offer limited specific recommendations for antithrombotic regimens after Watchman implantation.
Purpose of the Study:
- To compare the clinical outcomes of two different antithrombotic strategies following Watchman LAAC.
- To evaluate the efficacy and safety of a 3-month dual antiplatelet therapy (DAPT) versus a shorter course of anticoagulation plus aspirin followed by DAPT (ACT group).
- To determine the preferred antithrombotic regimen for patients undergoing LAAC.
Main Methods:
- Retrospective analysis of two German hospital registries (Coburg and Lichtenfels) involving patients with successful Watchman LAAC.
- Comparison of 174 patients on 3-month DAPT with 174 patients on ACT (45 days anticoagulation + aspirin, then DAPT) after propensity score matching.
- Primary endpoints included thromboembolic events, cardiovascular/unexplained death, and major bleeding events at 12-month follow-up.
Main Results:
- Baseline characteristics including age, CHA2DS2-VASc, and HAS-BLED scores were similar between the DAPT and ACT groups.
- No significant differences were observed in the primary efficacy endpoint (thromboembolic events/death) between the groups (7.4% vs 6.3%, P=.66).
- The primary safety endpoint (major bleeding events) and the combined hazard endpoint were also comparable between the DAPT and ACT groups.
Conclusions:
- A 3-month DAPT regimen is as effective and safe as a shorter ACT regimen (6 weeks) plus aspirin following Watchman LAAC.
- These findings suggest flexibility in choosing antithrombotic therapy post-LAAC, with comparable outcomes for both strategies.
- Further prospective studies may be warranted to confirm these findings and refine antithrombotic recommendations.
Background:
Optimal antithrombotic therapy following left atrial appendage closure (LAAC) with the Watchman occluder remains uncertain. This study retrospectively compared clinical outcomes of a 3-month dual antiplatelet therapy (DAPT group) and a protocol of anticoagulation plus aspirin for 45 days followed by DAPT for 6 months (ACT group) after LAAC with the Watchman device.
Methods:
Of two Watchman registries (Coburg and Lichtenfels hospitals, Germany), 220 and 304 consecutive patients with successful LAAC were included. Patients in Coburg hospital received DAPT while they received ACT in Lichtenfels. After a 1:1 propensity score matching, 174 (DAPT) versus 174 (ACT) patients were compared by use of the primary efficacy endpoint of thromboembolic events and cardiovascular/unexplained death, the primary safety endpoint of nonprocedural related major bleeding events at follow-up, and the combined hazard endpoint, a composite of all above-mentioned hazards.
Results:
The mean age 77.5 ± 7.2 (DAPT) versus 77.3 ± 7.1 (ACT) years, CHA2 DS2 -VASc score 4.6 ± 1.5 versus 4.7 ± 1.6, and HAS-BLED score 3.3 ± 0.8 versus 3.3 ± 0.8 were similar. After 12 months, the clinical efficacy (13/174, 7.4% [DAPT] vs 11/174, 6.3% [ACT]; hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.38-1.86; P = .66) and safety (6/174, 3.4% vs 8/174, 4.5%; HR, 0.86; 95% CI, 0.29-2.56; P = .79) as well as the combined hazard endpoint (18/174, 10.3% vs 18/174, 10.3%; HR,1.01; 95% CI, 0.53-1.95; P = .97) were comparable.
Conclusions:
This study suggests comparable efficacy and safety of 3-month DAPT versus 6 weeks ACT plus aspirin following LAAC with the Watchman.
