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Optimal anticoagulation or antiplatelet therapy following LAA closure with Watchman device is still to be determined. Majority of studies evaluated the use of vitamin K antagonist (VKA) post device implantation. Data evaluating NOAC is scarse. We aimed to investigate the clinical outcomes of NOAC compared to other therapies post Watchman device.
Pub Med and Cochrane databases were systematically searched for clinical studies comparing the clinical outcomes of NOAC and VKA/DAPT for patients who underwent Watchman device implantation. The endpoints were bleeding episodes, neurological events and device thrombus. We used fixed (I2 < 55%) otherwise random effect analysis using the Cochrane Handbook of Systematic Reviews.
A total of four studies provided a total of 1340 patients (341=NOAC; 999=VKA/DAPT). Analysis results showed no difference in bleeding events in NOAC compared to VKA/DAPT group (2.3% vs. 2.4%, p=0.9). There was no difference in neurological events (0.3% vs. 0.4%, p=0.9) and device thrombus (0.8% vs. 1.4%, p=0.7) between the 2 groups.
Our analysis suggests that the use of NOAC post Watchman device implantation compared to traditional VKA or DAPT use is non-inferior as it leads to similar major clinical outcomes. Clinical trials should be done to investigate the ideal length of NOAC therapy post Watchman.