6 week Follow up TEE after Watchman implant

Re: 6 week Follow up TEE after Watchman implant

Carey — Mon, 14 Mar 2022 20:42:22 +0000

Drug companies include people of all sizes in clinical studies. The dosages chosen come from early studies designed specifically to find the best dosages, which means if they find there's a significant difference in safety or efficacy for a very large vs. a very small person, they'll have to choose multiple dosages for weight ranges. But most drugs do have a dosage that works equally well for all adults regardless of size, and that includes the NOACs.

In pediatrics it's quite different. Many drugs used in pediatrics are dosed based on the child's weight.

Re: 6 week Follow up TEE after Watchman implant

Poppino — Mon, 14 Mar 2022 14:53:00 +0000

A vg point. Ive qustioned the same criteria. If you are 80 its 5 mg. If you are thin 125-30? 5 mg. Ok so what if you are 75 and 150? Wouldnt 7.5 mg be logical? How can it be black and white? It cant. Ive read that some cardiology is confident that 5 mg is enough period even in LAA isolation. But i dont question Dr Natale. He knows more than me lol

Re: 6 week Follow up TEE after Watchman implant

ggheld — Mon, 14 Mar 2022 12:57:59 +0000

I haven't seen data on this but since all the NOAC's are 'one size fits all' drugs there has to be some difference in effectivity on a large person than a snall one, even the half dose.

It would make sense that at +200 lb man and a -130 lb woman wold have different effects from the same dosage of an NOAC or most anything else, for that matter.

The CHADS formula, [clincalc.com] doesn't take into account weight or size. According to the Wall St. Journal, many physicians are deemphasizing weight check on office visits, one reason being that some patients may skip visits if they have to have weight recorded. [www.wsj.com] so maybe one size fits all applies to everything except Flecainide.

Re: 6 week Follow up TEE after Watchman implant

Poppino — Mon, 14 Mar 2022 00:42:04 +0000

And Carey is correct. Taking eliquis doesnt need to be enhanced with other clot protection. But! Say someone has the Watchman. Goes off eliquis but wants natural anticoagulation? We all know of Natto Garlic Ginger Wobenzyme Fish Oil etc etc. that person could be me? Idk yet. We ll see. TEE 3/31 then im sure eliquis is continued then??? So no crystal ball but i enjoy trying to figure. For me exercise supplements muscle longevity fitness flexibility is sorta an ocd hobby. It’s probably part of why i got afib
I was 47 playing in a mens basketball league. Excessive sports. Alcohol. Etc. Now i try and be a bit wiser. At 68 not much choice. It does seem Natale locked my flutter up
Soon i wanna post something he told me about : the autonomic nervous system. Incredible

Re: 6 week Follow up TEE after Watchman implant

Poppino — Mon, 14 Mar 2022 00:06:32 +0000

We do use olive oil in cooking. I also use avacado oil cod oil and walnut oil
I eat seeds walnuts almonds yogurt cashews dark chocolate coffee lecithin granules coq10 400 mg
D C 4-5000 breaers yst cocnut water. Water.probiotics mag . Zinc Milk thistle etc etc. Heart isnt my only target so as i get older i try to pour in anything that might help
Longevity. Are genes greater? Yes. My dad is 95 and talks like i do
We eat alota salmon. Blueberries raspberries salads But i may kick the bucket tomight

Re: 6 week Follow up TEE after Watchman implant

susan.d — Sun, 13 Mar 2022 23:00:42 +0000

I would think a swig of olive oil and fish oil supplement plus a half dose of Eliquis wouldn’t hurt the first 45 days after a watchman until the next TEE can determine if one is leaking or not….especially if you have a bi-annual Boston lab and Quest tests for platelet size and it’s high.

Interesting Tom, I saw my GP the other day and told him my high CHAD score and my new watchman and my reduced to half Eliquis dosage change. He told me to add olive oil to my diet and then he took a d-dimer test out of the blue.

Re: 6 week Follow up TEE after Watchman implant

Carey — Sun, 13 Mar 2022 22:43:11 +0000

I'm skeptical that the clot protection provided by DOACs like Eliquis need to be enhanced, or that it's even helpful. Could be harmful. Remember that anticoagulation is always a balance between clot risk and bleed risk. And I wouldn't be so sure that a daily glug of olive oil provides a net positive benefit given the increased calorie intake.

How about just replacing all the cooking oil in the house with light olive oil? (Don't cook with extra virgin olive oil!)

Re: 6 week Follow up TEE after Watchman implant

GeorgeN — Sun, 13 Mar 2022 22:11:43 +0000

Quote
Poppino
There have been some very interesting stuff come out on the use of olive oil at reducing clot risk. I take a swig first thing every am on an empty stomach

Assume you are referring to this:

Quote

More frequent olive oil intake is associated with reduced platelet activation in obesity
Ruina Zhang 1, Alberto Moscona 1, Khrystyna Myndzar 1, Elliot Luttrell-Williams 1, Sally Vanegas 2, Melanie R Jay 2, Karry Calderon 1, Jeffrey S Berger 3, Sean P Heffron 4
Affiliations expand
PMID: 34627691 DOI: 10.1016/j.numecd.2021.08.038
Abstract
Background and aims: Obesity is an independent risk factor for atherosclerotic cardiovascular disease (CVD), and platelet hyperactivation in obesity may contribute to this association. Olive oil consumption is associated with lower cardiovascular disease (CVD) risk in the general population. However, little is known for individuals with obesity. We investigated whether olive oil intake is associated with platelet activation in obesity.

Methods and results: We assessed platelet activation (surface P-selectin expression) with and without thrombin exposure and diet composition in 63 patients with severe obesity. Among 63 subjects with obesity, the mean age was 32.2 ± 8.0 years and BMI 44.1 ± 8.5 kg/m2. Olive oil intake was stratified into <1 time/week (n = 21), 1-3 times/week (n = 18), ≥4 times/week (n = 24). Strata did not differ by age, BMI or platelet count. Unstimulated P-selectin expression did not differ by olive oil consumption. Subjects with more frequent olive oil intake exhibited lower P-selectin expression on submaximal thrombin exposure.

Conclusions: More frequent olive oil intake is associated with reduced thrombin-induced platelet activation in obesity.

Re: 6 week Follow up TEE after Watchman implant

Poppino — Sun, 13 Mar 2022 21:17:46 +0000

There have been some very interesting stuff come out on the use of olive oil at reducing clot risk. I take a swig first thing every am on an empty stomach

Re: 6 week Follow up TEE after Watchman implant

Carey — Sun, 13 Mar 2022 20:38:35 +0000

Quote
JayBros
For example, how do your carotid arteries look plaque-wise?

My carotids are free of plaque but my last TEE did detect mild aortic plaque. And that's why Natale recommended remaining on half-dose Eliquis and why my PCP and local EP agreed with him.

You'll find some aortic plaque in most people over 60, so just because you haven't been told it's there doesn't mean much.

Re: 6 week Follow up TEE after Watchman implant

JayBros — Sun, 13 Mar 2022 20:28:40 +0000

I'm probably out on a little thin ice on this but even with a Watchman, we must still be aware of other sources of clots that could cause a stroke. For example, how do your carotid arteries look plaque-wise? Mine are clean as a whistle but my wife, in the last ultrasound of them when she asked the technician how they looked replied, "I've seen worse." Possible DVTs developing?

Re: 6 week Follow up TEE after Watchman implant

tobherd — Sun, 13 Mar 2022 19:00:26 +0000

Thanks all for the good wishes and comment on my post above.

If there is no real reason for possibly having a stroke other than getting older...is that enough of a reason to stay on Eliquis?

I plan to take more Omega'3's, and another supplement that has been shown to help keep the blood thinner and less likely to clot. It was actually developed with Dr. John Folts, who the first to discover aspirin therapy for cardiovascular disease - and I would like to increase my current amount I am already taking. That should help reduce the chance of a blood clot.

Are any of you doing other things to prevent blood clots and hence a stroke? i am just not convinced that even low dose Eliquis is necessary if other measures are taken - especially after getting the Watchman.

Barb

Re: 6 week Follow up TEE after Watchman implant

Poppino — Tue, 08 Mar 2022 21:06:13 +0000

Great news Barb!!! I like Jay and Susan have my TEE 3/31 theirs are about the same date
Dr Natale agreed to let me have Dr Holshouser here in Charlotte do mine. He places The Watchman and i have great confidence in him
Austin sent their instructions as well

Re: 6 week Follow up TEE after Watchman implant

JayBros — Tue, 08 Mar 2022 14:01:31 +0000

Carey & Shannon, I very much appreciate your explanations. My 45-day TEE is 3/29 and I must say that the small touch up Dr. Natale did before the Watchman implant on 2/15 has made me feel better than I have in about six months. Dr. N put me on Xarelto before my major ablation in Aug '16 and I have tolerated it very well since as I did Pradaxa. It will be interesting to learn what The Maestro will prescribe after the TEE. Right now I'm on 10mg Xarelto and 81mg aspirin daily.

Re: 6 week Follow up TEE after Watchman implant

susan.d — Tue, 08 Mar 2022 06:56:43 +0000

Quote
Carey
I made that decision 3 years ago and remained on 1/2 dose Eliquis by carefully considered choice. I could have stopped everything but I didn't. I've explained my reasoning before but if you've never seen it let me know and I'll track down one of my posts and link to it or summarize it here..

Here it is.
[www.afibbers.org]
[www.afibbers.org]

Re: 6 week Follow up TEE after Watchman implant

Shannon — Tue, 08 Mar 2022 05:34:05 +0000

Great to hear it all went fine Barb as we discussed prior to the Watchman FLX install. And a low dose of Eliquis is quite benign so nothing really to worry about. In my book, it is a smart decision to go for a half dose of Eliqius plus the Watchman, especially for us somewhat older folks, mainly to help minimize any risks for a systemic stroke or TIA not related to LAA/AFIB-only embolic events which the Watchman well covers you for.

Be well,
Shannon

Re: 6 week Follow up TEE after Watchman implant

Carey — Tue, 08 Mar 2022 05:01:03 +0000

I made that decision 3 years ago and remained on 1/2 dose Eliquis by carefully considered choice. I could have stopped everything but I didn't. I've explained my reasoning before but if you've never seen it let me know and I'll track down one of my posts and link to it or summarize it here.

No matter what you decide, I completely agree with your decision to favor Eliquis over aspirin. There's just no comparison in safety and efficacy.

6 week Follow up TEE after Watchman implant

tobherd — Tue, 08 Mar 2022 02:19:02 +0000

HI all - I'm happy to report that I had my 6 week follow up TEE after Dr. Natale put in my Watchman, and all looks good! According to Dr. DiBiase, who works with Dr Natale when he comes to the NY area, I should be able to get off the blood thinners in June. Not sure why then as opposed to now, but I"m assuming it needs more time to fully "seat" in place? He mentioned getting off of Eliquis, and sounded like he was "iffy" on the aspirin. I told him if I had to stay on either one, I'd rather be on Eliquis (low dose). But I'm hoping to get off of BOTH.

My impression is that the Docs like to keep us on Eliquis for life as added protection as we get older. I know we could have a stroke from other causes as we age, but ....not a fan of staying on any med unless it really is needed.

Your thoughts? Barb