The WASPS Trails:WATCHMAN for Second Prevention of Stroke
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 400
- 试验地点
- 1
- 主要终点
- All stroke (including ischemic and hemorrhagic) and systemic embolism, cardiovascular death (limited to any cardiovascular and unexplained)
研究概览
简要总结
To evaluate the effects of mechanical left atrial appendage (LAA) closure for secondary prevention of stroke in the patients with nonvalvular atrial fibrillation
详细描述
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting an estimated 5 million Chinese. Atrial fibrillation is the primary cardiac abnormality associated with embolic stroke; among patients with AF, there is an annual stroke rate, about 5 times for the same age population in sinus rhythm.
Although warfarin therapy is effective at reducing the risk of stroke, chronic anticoagulation presents problems of safety and acceptability for many patients. Drug and dietary interactions, frequent blood tests, and compliance issues all contribute to difficulties with chronic warfarin therapy. New oral anticoagulant compounds with better therapeutic range and without need for similar monitoring, such as Dabigatran, Rivaroxaban, Apixaban and Edoxaban,have been studied, but there is no direct comparison with left atrial appendage closure(LAAC).
However,the left atrial appendage (LAA) is the major location of thrombi in patients with AF. In patients with nonrheumatic AF and thrombus in the left atrium, the clot was located in the LAA in 90%. And the WATCHMAN Left Atrial Appendage System is a novel device designed to prevent the embolization of thrombi that may form in the LAA. It is hypothesized that it may prevent ischemic stroke and systemic thromboembolism in patients with AF.The PROTECT-Af and PREVAIL trails confirmed this device's efficacy and safety, compared with warfarin, for preventing the combined outcome of stroke,systemic embolism, and cardiovascular death. And the device has been approved by China's FDA.
Stroke is the primary cause of death in China, and recurrence of stroke remains a major public health issue.
This cohort study is designed to evaluate the effects of mechanical left atrial appendage (LAA) closure for secondary prevention of ischemic stroke in the patients with nonvalvular atrial fibrillation in China, compared with medicine approach (Warfarin or NOAC),.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 18 years or older;
- •A history of stroke/transient ischemic attack(TIA) over 3 months;
- •Paroxysmal, persistent, or permanent nonvalvular AF;
- •4.2 or more CHA2DS2-VASc risk factors
- •Eligibility for long-term anticoagulation with warfarin or new oral anticoagulants.
排除标准
- •patent foramen ovale with atrial septal aneurysm
- •an atrial septal defect
- •mechanical valve prosthesis
- •left ventricular ejection fraction less than 30%
- •mobile aortic atheromata
- •symptomatic carotid disease
研究组 & 干预措施
WATCHMAN transplantation
This group will receive WATCHMAN device implantation.Device implantation included concomitant antithrombotic medication to facilitate device endothelialization: warfarin and aspirin for 45 days. To assess for device stability, peridevice leaks, and device-related thrombus, transesophageal echo (TEE) imaging was performed at 45 days, 6 months, and 12 months. When the 45-day TEE revealed minimal residual peridevice flow (jet width ≤5 mm) and no device-related thrombus, warfarin will be stopped and replaced by clopidogrel, 75 mg daily, until the 6-month visit, after which only aspirin was continued. If an adequate seal is not obtained or a thrombus is detected, patients continue taking warfarin until an adequate seal is attained or thrombus is resolved before transitioning to aspirin.
干预措施: WATCHMAN transplantation (Device)
Oral anticoagulant therapy
This group will take oral anticoagulant drugs(warfarin or the new oral anticoagulant drugs like Dabigatran ).
For patients taking warfarin, international normalized ratio (INR) monitoring wil be performed at least every 2 weeks for 6 months and at least monthly thereafter, targeting an INR between 2 and 3. Follow-up visits occurred twice annually after the first year, with neurological assessments at 12 months and yearly thereafter or whenever a neurological event is suspected.
干预措施: Oral anticoagulant drugs (Drug)
结局指标
主要结局
All stroke (including ischemic and hemorrhagic) and systemic embolism, cardiovascular death (limited to any cardiovascular and unexplained)
时间窗: 3 years
次要结局
- All-cause death(3 years)
- All the serious complications,including the surgery complications and major bleeding events.(3 years)