Percutaneous transcatheter device closure of left atrial appendage (LAA), patent foramen ovale (PFO) and atrial septal defect (ASD) are usually performed with unfractionated heparin (UFH) anticoagulation. Intravenous (IV) enoxaparin has shown a favorable safety/efficacy profile over UFH in percutaneous coronary intervention but has not been evaluated in structural heart procedures.

The aim of the study is to report a first experience using IV enoxaparin without anticoagulation monitoring in transcatheter structural heart interventions performed in the left atrium.

This retrospective, non-controlled study included all consecutive and unselected patients who underwent percutaneous LAA, PFO or ASD closure at a tertiary care center using IV enoxaparin anticoagulation. The primary composite endpoint was the occurrence of in-hospital death, embolic complications (stroke, transient ischemic attack, and peripheral arterial embolism) and bleedings defined as type 3a or more according to Bleeding Academic Consortium Research definition.

We enrolled 198 patients (mean age 60±18 years, 55% males) with an indication for LAA (40.4%), PFO (34.3%) or ASD closure (25.3%). The majority of patients (n=163, 82%) received a single IV enoxaparin dose of 0.5mg/kg. The composite endpoint occurred in 6 (3%) patients including 4 (2%) type 3a bleedings, one (0.5%) transient ischemic attack and one (0.5%) death from sepsis. Median follow-up was of 3.7 (3.2–4.4) months with a cumulative rate of the composite endpoint of 5.8% over this period (Table 1, Figure 1).

IV enoxaparin without monitoring appears as a safe, effective and easy-to-use alternative to UFH in percutaneous left atrial intervention.