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Objective: To determine if the WATCHMAN device is as efficacious as warfarin for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) using a systematic review. Methods: Pubmed and Google Scholar databases were used to evaluate clinical trials using the search terms atrial fibrillation, watchman, warfarin, and stroke prevention. Results: Three studies met inclusion criteria, with 2 being randomized control trials (RCT), and 1 being a prospective cohort study. Reddy et al found that after 3.8 years of follow-up, patients with percutaneous closure of Left atrial appendage (LAA) met criteria for both non-inferiority and superiority, compared with warfarin for preventing combined outcome for stroke. Holmes et al showed at 18 months follow-up that the WATCHMAN device and warfarin therapy groups had similar efficacy endpoints. The device group was shown to be non-inferior to the control group in late-ischemic stroke 7 days post procedure, and was found to be equally as safe. Boresma et al showed that at the 1-year follow-up there was a lower risk of stroke in the device group, and that the earliest discontinuation of anticoagulant therapy had the lowest risk of bleeding. Conclusion: This systematic review shows evidence that the WATCHMAN implantable LAA device may be a suitable alternative to prevent thromboembolism in patients with NVAF who may have a contraindication for long-term warfarin or anticoagulation use. Due to the novel technology of the WATCHMAN implant, more studies should be completed to determine its long-term efficacy and adverse events.
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