Effect of Caffeine on Adenosine Fractional Flow Reserve in Patients with Coronary Artery Disease

Abstract

anticoagulation regimen, however, remains undefined. In thePROTECT-AF trial, patientswere treatedwithwarfarin for 45 days post-Watchman deployment to allow device endothelialisation. The safety and efficacy of LAAO without short-term postoperative warfarin cover is not known. Methods: We prospectively followed patients after percutaneous LAAO with a Watchman device. Transoesophageal echocardiography (TOE) was performed one month post-procedure. Results: Our cohort consisted of 33 high-risk patients who were deemed ineligible for long-term warfarin therapy following discussion at our department’s multidisciplinary meeting. Median follow-up was 16 months (range, 3–37 months). Median age at time of procedure was 71 years, and 64% of patients were male. The median size of the Watchman devices successfully deployed was 21mm (range, 21–33mm). Five procedures (15%) were aborted due to unsuitable LAA anatomy. Peri-procedural complications included three episodes of pericardial effusion. Fatal intracranial haemorrhage occurred in one patient on dual anti-platelet therapy (DAPT) on day 40 post-procedure. Ten patients (36%) were maintained on warfarin four weeks post-operatively, 16 patients (57%) were treated with DAPT, and two patients had no anticoagulation because of absolute contraindications. At the time of analysis, no ischaemic stroke or thromboembolic complicationswere observed in either group.On progress TOE, device placement was deemed satisfactory in all cases. Conclusions:DAPT following percutaneous LAAOwith the Watchman device is not associated with increased short-term risk of thromboembolism compared with warfarin. http://dx.doi.org/10.1016/j.hlc.2013.05.320