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watchman LAA procedure pros and consI’ve had Chronic AFib for a couple of years, was recently admitted to hospital and diagnosed with congestive heart failure. Went to a new doctor for second opinion on how to get AFib under control. He wants me to have the Watchman LAA procedure performed in order to get me off of Xarelto. I previously had a severe stomach bleed that almost caused my death. After the Watchman procedure he plans on shocking my heart to get my heart into a good rhythm, out of constant AFib. Has anyone here had the Watchman procedure done and was it successful?
Goddess, March 6, 2018 10:29pm ESTBarbieh-I had the Watchman procedure done last November because I also had a very bad bleed from taking a blood thinner that landed me in the hospital last April with a hemoglobin of 4.2. After 2 transfusions my numbers were not coming up so the doctor came in to inform me that they were moving me to the ICU because they were afraid I was going to crash. Seriously?? A very scary time for me. My cardiologist told me about Watchman and then I got a second opinion and the second cardiologist told me the same thing. After much research, etc., I decided to go for it. There is a good video on YouTube that shows the whole procedure. Take the time and watch it. Went in for a TEE first to make sure that there were no clots in or around my heart and was scheduled the following week for insertion of the device. Procedure went smoothly. Afterwards the manufacturer recommends that you take a blood thinner and a baby aspirin for 45 days. I went on Coumadin during this time because I cannot take any of the newer drugs (I was taking Eliquis when I had the major bleed). I managed the Coumadin and the baby aspirin. Had to have another TEE to make sure that I was healing properly and I was so then I was switched over to a full aspirin and put on Plavix until I reached the 6 months mark. Here is where I had issues. Between the plavix and full aspirin my hemoglobin started to drop. Called the surgical team and was told to discuss with my cardiologist what he wanted to do. The manufacturer has protocols in place but each patient is different. I can only tolerate a baby aspirin so that is the only thing I’m taking currently. My hemoglobin is very slowly coming back up (with the help of iron infusions once a month) and is again stable even though it is not back in the standard range. At the 6 month mark, I meet with the surgical team for a checkup and in November (the year mark) I go in for another TEE to check out healing and to make sure there is no leakages. It isnt just having the device put in and you’re done. There is a lot of follow up (my cardiologist is seeing me once a month too) which is a good thing! Work closely with your cardiologist, ask a ton of questions and do some research on your own. That’s what I did.
Jeanamo, March 7, 2018 11:31am ESTGoddess...thanks for your post about having the Watchman procedure. I hope you will respond to another post in this forum by CaroleDiane who has also experienced a bleeding problem while taking Eliquis. Her EP is recommending an ablation....but it would be helpful for her to know about the Watchman procedure as well as a possible option and your first hand experience would be valuable. I hope that you will continue to do well and that the Watchman has worked well for you...now and for the future. Thanks for posting and continue to let us hear from you.Wishing you the best.Jean (My A-Fib Experience Community Leader)
dave205, March 8, 2018 1:55am ESTSeven Reasons New Data on Watchman Are Not PersuasiveJohn Mandrola, MDDISCLOSURES November 10, 2017https://www.medscape.com/viewarticle/888355#vp_1
dave205, August 27, 2018 11:04am EST
Thrombus on the Watchman LAA Occluder Tied to Higher Stroke Risk
Device-related thrombus mitigates the benefits of LAA closure relative to warfarin, but not relative to doing nothing at all, one expert says.
By Todd Neale May 14, 2018
BOSTON, MA—Patients who develop thrombus on the Watchman left atrial appendage (LAA) closure device (Boston Scientific) carry a greater risk of stroke or systemic embolism, and there are hints of a causal relationship, a new analysis shows.
Overall, 3.74% of patients in Watchman trials and registries had a device-related thrombus (DRT) detected, Vivek Reddy, MD (Icahn School of Medicine at Mount Sinai, New York, NY), reported at the Heart Rhythm Society 2018 Scientific Sessions here.
These patients had a more-than threefold increase in the risk of stroke or systemic embolism, as well as greater risks of major bleeding and hemorrhagic stroke. DRT was not associated with higher rates of cardiovascular or all-cause mortality.
How Does DRT Affect the Benefits of LAA Closure?
Serving as a discussant after Reddy’s presentation, David De Lurgio, MD (Emory University, Atlanta, GA), said, “DRT does continue to occur despite modifications of the device, despite increased training. It is something that is in the background and will be seen with the devices we know, including the Watchman device.
“What is a little alarming,” he continued, “is that the risk for DRT remains and extends well beyond the standard periods of anticoagulation, so there’s a big question about when are we out of the woods and is that something we can predict based on the patient profile or any other factors?”
De Lurgio pointed out that the factors associated with DRT in the current study parallel traditional stroke risk factors, “so that is maybe an insight into something we can do for these patients.”
He also alluded to the lower risk of intracranial hemorrhage that has been observed with the non-vitamin K antagonist oral anticoagulants (NOACs) when compared with warfarin to suggest another potential approach to improving outcomes in patients with DRT, who had higher risks of both ischemic and hemorrhagic stroke.
“The thought that there is an increased hemorrhagic stroke [risk], probably due to reinstitution of anticoagulation, does beg the question of whether there’s something we can do with different anticoagulants that are known to be associated with a lower intracranial hemorrhage should we see DRT,” De Lurgio said.
As for the impact of DRT, he said, “I do believe that DRT mitigates the benefits of left atrial appendage closure relative to warfarin . . . . However, it doesn’t mitigate the benefits of left atrial appendage closure with these devices relative to no therapy. And I think that’s a very important take-home message.”