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In patients with atrial fibrillation (AF), warfarin therapy lowers risk for stroke by about half, but it carries potential hazards and is difficult to manage. About 90% of left atrial thrombi caused by AF are thought to originate in the left atrial appendage (LAA). The WATCHMAN is an experimental device (not FDA-approved) that can be inserted via a percutaneous transseptal approach to seal the LAA ostium.
In a manufacturer-sponsored study, investigators randomized 707 adults with nonvalvular AF to closure of the LAA or to warfarin (target INR, 2.0–3.0). Patients who underwent LAA closure received warfarin for 45 days, followed by antiplatelet therapy. During a mean follow-up of 18 months, fewer primary endpoints (stroke, systemic embolism, o…