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Watchman dilemma

Posted by ron 
ron
Watchman dilemma
March 03, 2019 03:58PM
I am currently on Eliquis after my left appendage was ablated 2 1/2 years ago. I had considered a watchman, but up until now was mostly content with Eliquis. Something has come up that is making me rethink that choice. I have a prostate procedure coming up that will require me to be off blood thinners for at least 1 1/2 days and possibly a couple of weeks depending on which procedure I choose. This isn't an emergency (yet) and I have time measured in months to sort this out.

I missed the FLX trail and would be forced into the standard watchman (I think) at this time. After reading about the FLX, I would rather have it than the current procedure, but if the trial goes full length, it will be longer than I want to wait. Maybe, they will release it early but who knows for sure ?

One of the things I wonder about is the "real risk" of being off a blood thinner when the left appendage has been ablated. My at home EP along with my Urologist seem to think it is minimal, 2% ( their words). I am not so sure on that. The last thing Dr. Natale told me was.....Don't miss any doses of Eliquis.

Anyway, the way I see it, I only have a couple of choices....
1. Have the current approved watchman device put in place, wait til it is confirmed that it is doing it's job, then have the procedure.
2. Go off the blood thinner, use bridging to get me to the procedure, have the operation and resume Eliquis as soon as allowed.

Any comments would be welcome...RonH
Re: Watchman dilemma
March 03, 2019 05:25PM
You could possibly go on Lovonox injections in between. This is what Dr. Natale's office had me do when I had to go of of Elequis to have a nerve block done last year.



Edited 1 time(s). Last edit at 03/03/2019 07:04PM by rocketritch.
Re: Watchman dilemma
March 03, 2019 05:53PM
Your urologist is dead wrong. That 2% number is about right if your LAA hadn't been isolated, but since it was you're at much higher risk if you stop the Eliquis. As rocket mentioned, the usual procedure is to bridge you with heparin, and you can get Natale's office to provide your surgeon with their protocol for that. But stopping Eliquis for weeks would be really, really dangerous. I wouldn't do that and I'm sure Natale would tell you the same.

Rodney Horton, who is the Watchman guru at TCAI, presented data on this at HRS2018. The entire slide is too big to be readable, but here's the important part:



So you've got a difficult decision here, and you should call Natale's office for guidance, but I absolutely would not stop all anticoagulants for weeks.
Re: Watchman dilemma
March 04, 2019 02:17PM
I agree with Carey 100%. I was in the same situation taking Eliquis about 2 years ago, I possibly missed a dosage while on a trip and had a stroke. Or perhaps the Eliquis did not work for me because I was only on it for about a month. I'm presently doing Cognitive rehab therapy to try and get my memory working better. I lost my job after the stroke, I cannot speak well and I have issues with my right arm and right leg. Listen to Carey and Dr. Natale 100%.
Re: Watchman dilemma
March 04, 2019 03:08PM
Mike:

I recall when you wrote about having a stroke, it takes a long time to recover but you are getting there. I don't understand why when a person is on a blood thinner and stops it for a few days that they should stroke, why? That actually is scary, what happens when people have been on a blood thinner and then after an ablation or watchman they can then can go off it, can they possibly stroke even then?

L



Edited 1 time(s). Last edit at 03/04/2019 03:12PM by Elizabeth.
Re: Watchman dilemma
March 04, 2019 03:57PM
Quote
Elizabeth
I don't understand why when a person is on a blood thinner and stops it for a few days that they should stroke, why?

Strokes happen to people who are 100% compliant, too. There are no perfect anticoagulants. All of them reduce risk, but none completely eliminate it.

A stroke from missing one or two doses is unlikely for most people, but when your LAA has been isolated it often doesn't pump effectively anymore, which means that blood will tend to pool there even more than usual, and that pooling can lead to clots forming fairly quickly. One of the things Natale does if he isolates your LAA is to do a TEE six months later to measure the blood flow in and out of your LAA. If flow is sufficient to prevent pooling and your CHADS-Vasc score is low, you can stop anticoagulants. But if it's not adequate, you have to either remain on anticoagulants for life or have a procedure to occlude or remove your LAA (Watchman, Amplatzer, surgical clipping, etc).
Re: Watchman dilemma
March 04, 2019 09:50PM
Carey,
My way of thinking is, a stroke is more likely if you have, should we say bad blood.
Has any blood tests been done on those who have had strokes?
Re: Watchman dilemma
March 07, 2019 10:25PM
So I am in a similiar situation. I had a LAA isolation ablation done by Dr. Natale in 2013, and then a "touch up" by him in 2014. Afib free since then, and have been on Eliquis since my ablations too.

While I have had not problems on Eliquis, my brother in law DID. He fell in his kitchen and long story, short, ended up bleeding internally a lot, had to have his kidney and spleen removed, get on a feeding tube, and on and on. He is older and has Parkinson's, but I learned how hard it can be to stop the bleeding even in the hospital, which made me also rethink whether or not staying on Eliquis is a great idea.

I am waiting to hear back from Dr. DiBiase's office here in NY (he's Dr. Natale's protege)..for yet another TEE (this will be my 4th since my ablation, I believe). My last one about 6 months ago was good, but I believe I'm just over the line, so to speak..and they are a bit hesitant to just take me off of it. Dr. Natale wants me to get one more TEE, which I plan to do shortly. However, I don't want them to take me off of it if that would be putting me at risk of a stroke either. My cardiologist is in favor of a Watchman...I'm not sure.

By the way, Salwa, who's a nurse I believe, in Dr. Natale's office, said they don't use the CHADs score to determine this anymore...just the TEE. Has anyone else heard that?

Good luck Ron...I hope you get some answers soon too. ~ Barb
Re: Watchman dilemma
March 07, 2019 10:51PM
Quote
tobherd
By the way, Salwa, who's a nurse I believe, in Dr. Natale's office, said they don't use the CHADs score to determine this anymore...just the TEE. Has anyone else heard that?

Obviously I don't speak for Natale and his staff, but I don't think it's quite that simple. I believe they use the TEE to determine whether you can come off anticoagulants, but that's only if you have a low CHADS score to start with. I doubt they would okay it if you've got a high score. I could be wrong, but I have a hard time seeing them telling people with a CHADS 3+ to stop anticoagulants.
Re: Watchman dilemma
March 16, 2019 12:04AM
I’m very ignorant — what is the difference between LAA isolation and the Watchman? Why would one be done rather than the other?
Re: Watchman dilemma
March 16, 2019 01:27AM
Louise,

LAA isolation just means that an EP ablated the area surrounding your LAA.

A Watchman is a physical device that gets implanted into your heart. It's a thing they insert into your LAA to plug it.

Does that help clarify?
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