Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Left Atrial Appendage Closure D-PO02 - Poster Session II (ID 47) Poster

D-PO02-214 - Safety Of Left Atrial Appendage Closure With Watchman Device In Patients With Prior History Of Intracranial Bleeding: An Analysis From The Nationwide Readmissions Database (ID 1064)


Background: Watchman device is an alternative to long term anticoagulation in patients with high bleeding risk. Post implant antithrombotic regimen includes six weeks of anticoagulation and 4.5 months of dual antiplatelet therapy. The safety profile in those with prior intracranial hemorrhage (ICH) is unknown.
Objective: Assess and compare the safety of Watchman implantation in a large community cohort with and without prior history of ICH.
Methods: Using ICD 10 codes, we identified all patients within National Readmission Database (NRD) undergoing a Watchman implant between January 1-November 30, 2016. We compared all-cause rehospitalization rates between those with and without a history of ICH. Readmissions were confined to December 31, 2016.
Results: 2,723 patients (mean age 75.9±8.1, 38.6% females) underwent Watchman implant; 72 (2.6%) had a prior history of ICH. 21 (29.2%) patients with prior ICH and 562 (21.2%) patients without a history of ICH were rehospitalized (p=0.103). Non-traumatic IC bleeding (19%) was the most common cause of rehospitalization in patients with prior ICH and gastrointestinal bleeding (13.3%) in those without prior ICH. Mortality was higher in those rehospitalized with a prior history of ICH (n=2, 2.8%) as compared to those without (n=11, 0.3%; p = 0.001).
Conclusion: Early rehospitalization rates are similar after Watchman implantation in patients with and without prior history of ICH. Although there is a suggestion of higher mortality in those with prior ICH, the event rate is low. Watchman device may be an acceptable alternative for stroke prevention in those with prior IC bleeding, however, larger studies are necessary to confirm these findings.