Non-Vitamin K Oral Anticoagulant: Initiation or continuation of a NOAC drug
Study summary
The primary objective of this study is to determine if left atrial appendage closure (LAAC) with the WATCHMAN FLX device is a reasonable alternative to non-vitamin K oral anticoagulants in patients with non-valvular atrial fibrillation.
Eligibility
Sex
ALL
Min age
18 Years
Max age
—
Healthy volunteers
No
Inclusion Criteria:
* The subject is of legal age to participate in the study per the laws of their respective geography
* The subject has documented non-valvular atrial fibrillation (i.e., atrial fibrillation in the absence of moderate or greater mitral stenosis or a mechanical heart valve)
* The subject has a calculated CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category) score of 2 or greater for men and 3 or greater for women
* The subject is deemed to be suitable for the protocol-defined pharmacologic regimens in both the test and control arms
* The subject or legal representative is able to understand and willing to provide written informed consent to participate in the trial
* The subject is able and willing to return for required follow-up visits and examinations
Exclusion Criteria:
* Subjects who are currently enrolled in another investigational study, except when the subject is participating in a mandatory governmental registry, or a purely observational registry with no associated treatments
* The subject requires long-term anticoagulation therapy for reasons other than AF-related stroke risk reduction, for example due to an underlying hypercoagulable state (i.e., even if the device is implanted, the subjects would not be eligible to discontinue OAC due to other medical conditions requiring chronic OAC therapy)
* The subject is contraindicated or allergic to oral anticoagulation medication and/or aspirin
* The subject is indicated for chronic P2Y12 platelet inhibitor therapy
* The subject had or is planning to have any cardiac or non-cardiac intervention or surgical procedure within 30 days prior to or 60 days after implant (including, but not limited to: cardioversion, percutaneous coronary intervention (PCI), cardiac ablation, cataract surgery, etc.)
* The subject had a prior stroke (of any cause, whether ischemic or hemorrhagic) or transient ischemic attack (TIA) within the 30 days prior to enrollment
* The subject had a prior major bleeding event per ISTH definition within the 30 days prior to randomization. Lack of resolution of related clinical sequelae or planned and pending interventions to resolve bleeding/bleeding source, are a further exclusion regardless of timing of the bleeding event
* The subject has an active bleed
* The subject has a reversible cause of AF or transient AF
* The subject is absent of a left atrial appendage (LAA) or the LAA is surgically ligated
* The subject has had a myocardial infarction (MI) documented in the clinical record as either a non-ST elevation MI (NSTEMI) or as an ST-elevation MI (STEMI), with or without intervention, within 30 days prior to enrollment
* The subject has a history of atrial septal repair or has an atrial septal device (ASD)/patent foramen ovale (PFO) device
* The subject has an implanted mechanical valve prosthesis in any position
* The subject has a known contraindication to percutaneous catheterization procedure
* The subject has a known contraindication to transesophageal echo (TEE)
* The subject has a cardiac tumor
* The subject has signs/symptoms of acute or chronic pericarditis.
* The subject has an active infection
* There is evidence of tamponade physiology
* The subject has New York Heart Association Class IV Congestive Heart Failure at the time of enrollment
* The subject is of childbearing potential and is, or plans to become, pregnant during the time of the study (method of assessment upon study physician's discretion)
* The subject has a documented life expectancy of less than 3 years
Transthoracic Echo Exclusion Criteria:
* The subject has left ventricular ejection fraction ( LVEF) \< 30%
* The subject has an existing pericardial effusion with a circumferential echo-free space \> 5mm
* The subject has a high-risk PFO with an atrial septal aneurysm excursion \> 15mm or length \> 15mm
* The subject has significant mitral valve (MV) stenosis (i.e., MV area \<1.5 cm2)
Primary outcome measure(s)
WATCHMAN FLX is non-inferior (NI) for the occurrence of stroke, cardiovascular death, and systemic embolism — 36-months non-inferiority
WATCHMAN FLX is superior for non-procedural bleeding (ISTH major bleeding and clinically relevant non-major bleeding) — 36-months superiority
WATCHMAN FLX is non-inferior (NI) for the occurrence of ischemic stroke and systemic embolism — 60-months non-inferiority
Trial sites (141)
Facility
City
Region
Status
Grandview Medical Center
Birmingham
Alabama
University of Alabama at Birmingham
Birmingham
Alabama
Arizona Arrhythmia Research Center
Phoenix
Arizona
Phoenix Cardiovascular Research Group
Phoenix
Arizona
Scottsdale Healthcare - Shea
Scottsdale
Arizona
PIMA Heart and Vascular
Tucson
Arizona
Arrythmia Research Group
Jonesboro
Arkansas
Sharp Chula Vista Medical Center
Chula Vista
California
Marin General Hospital
Greenbrae
California
Scripps Memorial Hospital
La Jolla
California
Los Robles Hospital and Medical Center
Los Angeles
California
El Camino Hospital
Mountain View
California
Eisenhower Medical Center
Rancho Mirage
California
Mercy General Hospital
Sacramento
California
Santa Barbara Cottage Hospital
Santa Barbara
California
St. John's Health Center
Santa Monica
California
Colorado Springs Cardiologist, P.C.
Colorado Springs
Colorado
Yale University School of Medicine
New Haven
Connecticut
Christiana Hospital
Newark
Delaware
Washington Hospital Center
Washington D.C.
District of Columbia
Manatee Memorial Hospital
Bradenton
Florida
Bay Area Cardiology Associates, P.A.
Brandon
Florida
Broward General Medical Center
Fort Lauderdale
Florida
St. Vincent's Medical Center
Jacksonville
Florida
Lakeland Regional Medical Center
Lakeland
Florida
Baptist Hospital of Miami
Miami
Florida
AdventHealth Orlando
Orlando
Florida
Tallahassee Memorial Hospital
Tallahassee
Florida
Piedmont Hospital
Atlanta
Georgia
Emory University Hospital
Atlanta
Georgia
Memorial Health University Medical Center
Savannah
Georgia
Northwestern Memorial Hospital
Chicago
Illinois
Advocate Christ Medical Center
Oak Lawn
Illinois
St. John's Hospital
Springfield
Illinois
Franciscan Health Indianapolis
Indianapolis
Indiana
Community Hospital
Munster
Indiana
Mercy Hospital Medical Center
Des Moines
Iowa
University of Iowa Hospitals and Clinics
Iowa City
Iowa
University of Kansas Hospital
Kansas City
Kansas
Norton Hospital
Louisville
Kentucky
+ 101 more sites — see the full list on the official registry below.
More Boston Scientific Corporation trials in the USA
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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