Association between rates of ischemic stroke and all-cause mortality with the Watchman device compared to warfarin and direct oral anticoagulants in patients with atrial fibrillation

Abstract

Introduction: The Watchman device is approved in the US, but little is known about Watchman's ischemic stroke reduction compared to the newer direct oral anticoagulants (DOACs). This study explored the differences in ischemic stroke reduction between the Watchman device, warfarin, and DOAC medication.

Methods: Three patient cohorts, each containing 10,969 patients, were created using TriNetX. The primary and secondary endpoints were the ischemic stroke risk and all-cause mortality risk at 1 and 5 years.

Results: At 1 year, the Watchman device's relative risk of ischemic stroke was 0.86 against warfarin but 1.27 against DOACs (P < 0.0001). The relative risk of ischemic stroke between the Watchman and DOACs was higher at 1 and 5 years (1.27 and 1.30, P < 0.0001). The relative risk of all-cause mortality at 1 and 5 years was 0.49 and 0.72 for the Watchman device compared to warfarin (P < 0.0001) and 0.66 and 0.92 between the Watchman and DOACs (P < 0.0001 and 0.01).

Conclusion: While DOACs were associated with lower ischemic stroke rates, treatment with the Watchman device was associated with lower all-cause mortality. Patients placed on the Watchman device due to DOAC contraindications may benefit from its lower all-cause mortality risk.

Keywords: Atrial fibrillation; complications; left atrial appendage closure; stroke prevention; watchman device.