Dabigatran Versus Warfarin Post-Left Atrial Appendage Occlusion

According to a recent study, the use of short-term, low-dose dabigatran could significantly reduce the risk of bleeding compared with warfarin in post-percutaneous left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF). The study’s authors, led by Henge Ge, noted that dabigatran increased the risk of device-related thrombosis (DRT). Their findings were presented in Science Progress.

This retrospective, observational study included 84 patients with AF who were undergoing LAAO with a Watchman device. Participants received either dabigatran 110 mg twice daily (n = 38) or warfarin (n = 46) during the procedure and for 45 days afterwards. Transesophageal echocardiography was performed at 6 weeks, 6 months, and 12 months post-LAAO to assess the device and DRT.

Complications occurred during the procedure in 3 patients in the dabigatran group and 7 patients in the warfarin group (P=.30). Over the 12-month follow-up period, the warfarin group had 1 major bleeding event and 16 minor bleeding events compared with 0 and 5, respectively, in the dabigatran group (34.8% vs 13.2%; P=.02), the authors reported.

Notably, the incidence of DRT was higher in the dabigatran group compared with the warfarin group (15.8% vs 2.2%; P=.03), although no DRT-related ischemic events were observed.

Given their findings, the authors advanced that low-dose dabigatran should be used with caution for post-implant anticoagulation of LAAO, and they called for further trials on the safety and efficacy of direct oral anticoagulants in patients with AF who undergo LAAO.

Find more recent studies on the Atrial Fibrillation Knowledge Hub