To watchman or not I am trying to reach a decision about whether to have a watchman implant. A few months ago I suffered a fall, which resulted in some mild brain bleeds. I was on eliquis at the time. I went off eliquis for 8 weeks and then resumed. Originally, I thought the watchman would allow me to avoid all anticoagulation, but now see it will require indefinite aspirin, not to mention 6 months of aspirin plus plavix. Plavix has a worse bleeding risk than eliquis and aspirin and eliquis seem about statistically even, so what does the watchman do for me, other than add the risk of device related thrombus to my already elevated stroke risk? Also, it seems that any leaks in watchman are risky, not just leaks over 5mm. Makes some sense to me since once the device is in, any blood inside the LAA will clot and any way out would be dangerous. Since many posters here have had a watchman, I was wondering what made you reach that decision. Thanks. https://www.afibbers.org/forum/read.php?9,186734,186734#msg-186734 Tue, 25 Aug 2026 13:39:31 +0000 Phorum 5.2.23 https://www.afibbers.org/forum/read.php?9,186734,186921#msg-186921 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186921#msg-186921 JayBros AFIBBERS FORUM Tue, 30 Aug 2022 15:57:24 +0000 https://www.afibbers.org/forum/read.php?9,186734,186850#msg-186850 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186850#msg-186850 Carey AFIBBERS FORUM Fri, 26 Aug 2022 04:28:41 +0000 https://www.afibbers.org/forum/read.php?9,186734,186847#msg-186847 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186847#msg-186847 www.watchman.com]

Actually, Boston Scientific recommends a minimum of one year of aspirin in the UK. My French isn’t good enough to look up the recommendation there.]]> jasams AFIBBERS FORUM Fri, 26 Aug 2022 01:12:41 +0000 https://www.afibbers.org/forum/read.php?9,186734,186840#msg-186840 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186840#msg-186840 not recommend lifelong aspirin for the Watchman in Europe. Their recommendations actually leave it up to the doctor. They recommend anticoagulation, dual-antiplatelet, or NOAC plus aspirin for at least three months. But they leave the door open to the doctor to make whatever decision they see fit, including no NOAC or aspirin at all. So clearly the lifelong aspirin recommendation was added by the FDA, not BS.]]> Carey AFIBBERS FORUM Thu, 25 Aug 2022 20:13:39 +0000 https://www.afibbers.org/forum/read.php?9,186734,186839#msg-186839 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186839#msg-186839 jasams AFIBBERS FORUM Thu, 25 Aug 2022 17:23:22 +0000 https://www.afibbers.org/forum/read.php?9,186734,186814#msg-186814 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186814#msg-186814
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Cookie24
Carey,
Please explain why short-term aspirin is required.

When the Watchman is first placed you have a foreign object made of metal and fabric that's in direct contact with the blood flowing in your heart. Blood tends to coagulate on foreign objects and form clots, so you need something to prevent that from happening. Within 6 weeks, the endothelial tissue that lines the inner surfaces of your heart will grow over the device, completely enveloping it. This is called endothelialization. Once that happens, the Watchman is no longer exposed to blood so it can't form clots.

Why does the FDA recommend lifelong aspirin? Frankly, it's mostly out of a compulsion to "do something." They envision a rare scenario where the endothelialization is incomplete, so they recommend aspirin to guard against that possibility. They apparently think the risk of that is higher than the risk that aspirin presents. I'm unaware of any data supporting that notion, and I am aware of a number of experts in the field who disagree.]]> Carey AFIBBERS FORUM Tue, 23 Aug 2022 22:38:41 +0000 https://www.afibbers.org/forum/read.php?9,186734,186813#msg-186813 :)ovRe: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186813#msg-186813
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gloaming
You really ought to consider posting this separately in a new thread. Yes, it's relevant, especially to you, but it is also informative for onlookers who may have the same concerns. It's an education forum after all, where we share experiences and try to help others to make sense of what they're about to experience or what they're currently experiencing.

However, the watchman is an inert metal cage not very dissimilar to cervical protection diaphragm. It gets placed in the left atrial appendage and is left there. The reason we take anticoagulants is chiefly because of the risk of thrombosis in the LAA. The Watchman device is hoped, with accumulated empirical evidence, to be able to obviate

Thank you for your reply. I will try to post this as a new topic.

This is such a great group. I am sure I will embarrass myself with this question, but here it goes! I just bought a Philips Sonicare toothbrush. I am reading the instructions and it says, “ if you have a pacemaker or other implanted device, contact your physician or the device manufacturer prior to use”. So, here I am taking everything literally. How does a watchman, which is implanted, relate to this?

Please don’t laugh at this one……..

By the way, I probably should have posted this as a new topic. Hope it does not get lost in this string.
]]> Pixie AFIBBERS FORUM Tue, 23 Aug 2022 22:13:43 +0000 https://www.afibbers.org/forum/read.php?9,186734,186811#msg-186811 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186811#msg-186811
“You could infer that Boston Scientific believes that "you can suspend all anticoagulants permanently" with the Watchman since the Champion AF Clinical Trial will determine if the Watchman FLX is a reasonable alternative for D/NOACs. Report date is December 2027.”


As I understand it, the Champion-AF trial compares the watchman flx to long-term DOAC. Those in the watchman arm will take either a DOAC or dual anti platelet therapy for 3 months and then switch to aspirin indefinitely.]]> jasams AFIBBERS FORUM Tue, 23 Aug 2022 22:03:28 +0000 https://www.afibbers.org/forum/read.php?9,186734,186810#msg-186810 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186810#msg-186810
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jasams
I don’t think you can suspend all anticoagulants permanently or the company would be pushing for approval of that instead of merely switching the initial 6 weeks from warfarin and aspirin to a dual antiplatelet.

You could infer that Boston Scientific believes that "you can suspend all anticoagulants permanently" with the Watchman since the Champion AF Clinical Trial will determine if the Watchman FLX is a reasonable alternative for D/NOACs. Report date is December 2027.

Champion AF Clinical Trial]]> JakeL AFIBBERS FORUM Tue, 23 Aug 2022 21:25:01 +0000 https://www.afibbers.org/forum/read.php?9,186734,186803#msg-186803 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186803#msg-186803 Cookie24 AFIBBERS FORUM Tue, 23 Aug 2022 17:49:09 +0000 https://www.afibbers.org/forum/read.php?9,186734,186802#msg-186802 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186802#msg-186802 Thanks for posting this information about post-Watchman protocol. I am glad to hear I can remain on Eliquis and do not have to switch to another anti-coagulant. Please explain why short-term aspirin is required. I recently had an ablation by Dr. Santangeli at Penn Medicine and he recommended a Watchman. He said I could remain on Eliquis also. This double protection protocol I learned about from Shannon and this forum. Jill]]> Cookie24 AFIBBERS FORUM Tue, 23 Aug 2022 17:47:42 +0000 https://www.afibbers.org/forum/read.php?9,186734,186801#msg-186801 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186801#msg-186801
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Pixie
This is such a great group. I am sure I will embarrass myself with this question, but here it goes! I just bought a Philips Sonicare toothbrush. I am reading the instructions and it says, “ if you have a pacemaker or other implanted device, contact your physician or the device manufacturer prior to use”. So, here I am taking everything literally. How does a watchman, which is implanted, relate to this?

Please don’t laugh at this one……..

By the way, I probably should have posted this as a new topic. Hope it does not get lost in this string.

You really ought to consider posting this separately in a new thread. Yes, it's relevant, especially to you, but it is also informative for onlookers who may have the same concerns. It's an education forum after all, where we share experiences and try to help others to make sense of what they're about to experience or what they're currently experiencing.

However, the watchman is an inert metal cage not very dissimilar to cervical protection diaphragm. It gets placed in the left atrial appendage and is left there. The reason we take anticoagulants is chiefly because of the risk of thrombosis in the LAA. The Watchman device is hoped, with accumulated empirical evidence, to be able to obviate anticoagulants.]]> gloaming AFIBBERS FORUM Tue, 23 Aug 2022 17:28:31 +0000 https://www.afibbers.org/forum/read.php?9,186734,186798#msg-186798 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186798#msg-186798 jasams AFIBBERS FORUM Tue, 23 Aug 2022 16:31:57 +0000 https://www.afibbers.org/forum/read.php?9,186734,186796#msg-186796 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186796#msg-186796
Please don’t laugh at this one……..

By the way, I probably should have posted this as a new topic. Hope it does not get lost in this string.]]> Pixie AFIBBERS FORUM Tue, 23 Aug 2022 16:12:08 +0000 https://www.afibbers.org/forum/read.php?9,186734,186793#msg-186793 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186793#msg-186793
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jasams
I don’t think you can suspend all anticoagulants permanently or the company would be pushing for approval of that instead of merely switching the initial 6 weeks from warfarin and aspirin to a dual antiplatelet.

It's done in Europe routinely. Where do you get the idea that dual antiplatelet drugs are required? That's true only for the first six months, and only in the official recommendations. In practice, that's rarely done, and never beyond six months.

As for pushing for FDA approval of no anticoagulants, that's not how FDA approvals work. The FDA establishes recommended usages when a drug or device is first approved. Those recommendations generally don't change even if reality does. For example, flecainide, which received FDA approval 38 years ago, still isn't recommended for use in atrial fibrillation, and yet it's a mainstay of treatment for it today and has been for years. Why? Because the FDA recommendations written in 1984 have never been changed. Even when it was still under patent the manufacturer never sought that change. Why? Because the FDA would require all new clinical trials specifically to prove if it was safe and effective for afib, which would cost millions of dollars, and that would be of no benefit to the company because doctors are free to use the drug as they see fit no matter what the FDA said in 1984. So for the same reason, Boston Scientific has no reason to seek a change in the FDA recommendations for the Watchman. Doctors are already seeing that those recommendations are overly conservative and modifying them to fit reality.

So you really shouldn't go by what the FDA said several years ago when they first approved the device. You should go by what leading doctors are actually doing in real practice. For the majority that probably means OAC + aspirin for 6 weeks, followed by aspirin indefinitely. For the leaders, it means OAC + aspirin for 6 weeks followed by either nothing or low-dose OAC indefinitely depending on the patient's particulars.]]> Carey AFIBBERS FORUM Tue, 23 Aug 2022 14:55:02 +0000 https://www.afibbers.org/forum/read.php?9,186734,186789#msg-186789 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186789#msg-186789 jasams AFIBBERS FORUM Tue, 23 Aug 2022 13:30:09 +0000 https://www.afibbers.org/forum/read.php?9,186734,186786#msg-186786 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186786#msg-186786
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Daisy
So indulge me while I ask a basic question: If you get a Watchman without having your LAA isolated, wouldn't the Watchman itself prevent any errant signals from coming out of the LAA, eliminating the need for it to be isolated through ablation?

Nope; a Watchman just sits in the opening of the LAA with tiny wires that extend maybe a millimeter or two into the tissue to hold it in place. There's nothing there that stops electrical activity.]]> Carey AFIBBERS FORUM Tue, 23 Aug 2022 01:11:55 +0000 https://www.afibbers.org/forum/read.php?9,186734,186783#msg-186783 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186783#msg-186783
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Carey
Isolating the LAA doesn't mean making burns in the LAA itself just as a PVI doesn't mean making burns in the pulmonary veins themselves. It means making burns around those structures, creating a fence that blocks errant signals from coming out of them.

So indulge me while I ask a basic question: If you get a Watchman without having your LAA isolated, wouldn't the Watchman itself prevent any errant signals from coming out of the LAA, eliminating the need for it to be isolated through ablation?]]> Daisy AFIBBERS FORUM Tue, 23 Aug 2022 00:03:46 +0000 https://www.afibbers.org/forum/read.php?9,186734,186776#msg-186776 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186776#msg-186776
That’s why I wrote not ideal —but a lot of choices in life are not perfectly ideal but compromises are made for the overall good. One makes the best of the situation and uses a highly skilled EP.]]> susan.d AFIBBERS FORUM Mon, 22 Aug 2022 20:03:08 +0000 https://www.afibbers.org/forum/read.php?9,186734,186772#msg-186772 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186772#msg-186772 around those structures, creating a fence that blocks errant signals from coming out of them. So the presence of a Watchman might complicate the procedure, but it doesn't make it impossible, as Susan's second link states.

Keep in mind that most EPs don't have the training necessary to perform LAA isolations in the first place. It's a relatively new approach so it's not surprising that most EPs don't have this training and experience.]]> Carey AFIBBERS FORUM Mon, 22 Aug 2022 14:42:33 +0000 https://www.afibbers.org/forum/read.php?9,186734,186771#msg-186771 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186771#msg-186771 [www.ncbi.nlm.nih.gov]

A negative link:
[pubmed.ncbi.nlm.nih.gov]

“ Electrical isolation of the LAA could be difficult and when attempted can result in increased risk of short-term peri-device leak and recurrence of AT/AF in almost all patients.”
It probably depends on the EP’s skill]]> susan.d AFIBBERS FORUM Mon, 22 Aug 2022 13:14:26 +0000 https://www.afibbers.org/forum/read.php?9,186734,186770#msg-186770 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186770#msg-186770

That’s what I was told by EP’s office.]]> jasams AFIBBERS FORUM Mon, 22 Aug 2022 09:38:03 +0000 https://www.afibbers.org/forum/read.php?9,186734,186765#msg-186765 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186765#msg-186765
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jasams
My LAA has not been ablated, which is another issue. If I get a watchman now, there would be no way to ablate it in the future

That is not true. Where are you getting your information?]]> Carey AFIBBERS FORUM Mon, 22 Aug 2022 03:17:17 +0000 https://www.afibbers.org/forum/read.php?9,186734,186764#msg-186764 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186764#msg-186764 jasams AFIBBERS FORUM Mon, 22 Aug 2022 03:10:09 +0000 https://www.afibbers.org/forum/read.php?9,186734,186760#msg-186760 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186760#msg-186760
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jasams
You do make a good point about needing to spend time off the anticoagulant for medical procedures. I think the percentage risk for a few days would be incredibly low, although not zero. It’s not zero with the watchman either.

I think it is very important when discussing whether to get the Watchman to factor in whether your LAA has been isolated. If it has, and the circulation velocity in the LAA is not up to scratch, then you are at a very significant risk of a stroke if you miss doses of you anticoagulant or need to stop it for a medical procedure. If you LAA is NOT isolated, it is not such an issue. In the former case, getting a Watchman could be lifesaving.

If your LAA is not isolated then the discussion is very different, and you are right that missing a few days of your anticoagulant in order to get a medical procedure, is not such a big deal. And then there is the insurance issue: it will pay if your LAA is isolated or you are unable to take an anticoagulant for some reason. It probably won't (right now anyway) if you opt for a Watchman just for preference.]]> Daisy AFIBBERS FORUM Mon, 22 Aug 2022 00:44:21 +0000 https://www.afibbers.org/forum/read.php?9,186734,186754#msg-186754 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186754#msg-186754
Your other points are well taken. I’m just overwhelmed at the moment by this journey. Thanks for replying.]]> jasams AFIBBERS FORUM Sun, 21 Aug 2022 23:26:27 +0000 https://www.afibbers.org/forum/read.php?9,186734,186753#msg-186753 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186753#msg-186753
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jasams
Thanks Carey, So I guess put another way, you feel that a watchman plus OAC is better than either alone. That’s certainly possible. My concern right now is that at age 65, if I’m lucky, I could live another 20-30 years. The watchman is permanent choice and there isn’t any long-term data about how it will perform over time. Why not stay on OAC until I’m older. Perhaps better treatments will come along. There probably is no answer, like most things in medicine.

If you live as long as you hope, you will probably live to see afib cured. I think it's likely within 10-15 years. Care to gamble on waiting for that because of your concern over a 2-3% complication rate that extremely rarely leads to death or disability?

All you can do in life is bet on the odds, and the odds are in your favor with a Watchman implanted by an experienced operator vs years on an OAC. Susan made an excellent point about forgetting your Eliquis, care givers forgetting it, having to come off it for medical procedures, losing it while traveling, etc. You know darn well that in the next 20-30 years you will go without Eliquis for some periods of time. It's unavoidable. That was one of my driving reasons for going for the Watchman.]]> Carey AFIBBERS FORUM Sun, 21 Aug 2022 22:54:57 +0000 https://www.afibbers.org/forum/read.php?9,186734,186751#msg-186751 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186751#msg-186751
You do make a good point about needing to spend time off the anticoagulant for medical procedures. I think the percentage risk for a few days would be incredibly low, although not zero. It’s not zero with the watchman either.

The new watchman flx is safer than the original watchman 2.5 and it’s reasonable to assume future iterations will be even safer and more efficacious. Of course, given the FDA approval process, the availability of such devices could be years away.]]> jasams AFIBBERS FORUM Sun, 21 Aug 2022 19:33:18 +0000 https://www.afibbers.org/forum/read.php?9,186734,186750#msg-186750 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186750#msg-186750
Plus what if you need immediate surgery? I did and was put into the icu until all half-life if Eliquis was eliminated from my body so I could get my pacemaker. He wanted me to not resume Eliquis for 5 days but with advice of my EP I started and had a hematoma the size of a large orange. It took a long time to get rid of it. Tooth surgery, colonoscopy etc you will have to wean off and bridge with a shorter half life drug before the procedure and maybe stop afterwards your Eliquis.

Plus many surgeons just want you to stop all together for 5 or so days. I wanted my gallbladder out and the surgeon refused to operate unless I stopped Eliquis.

Now with a watchman if I forget a dose I don’t worry and I went off 5 days after my colonoscopy.

Obviously you can wait but if you need any surgeries or procedures done there is an increase risk for a stroke. Probably small but do you want to chance it. My father has about 12-14 strokes (lost count) and was a prior professional baseball player who turned into a vegetable. It’s a decision you have to make that is regrets free.]]> susan.d AFIBBERS FORUM Sun, 21 Aug 2022 18:39:26 +0000 https://www.afibbers.org/forum/read.php?9,186734,186748#msg-186748 Re: To watchman or not https://www.afibbers.org/forum/read.php?9,186734,186748#msg-186748 plus OAC is better than either alone. That’s certainly possible. My concern right now is that at age 65, if I’m lucky, I could live another 20-30 years. The watchman is permanent choice and there isn’t any long-term data about how it will perform over time. Why not stay on OAC until I’m older. Perhaps better treatments will come along. There probably is no answer, like most things in medicine.]]> jasams AFIBBERS FORUM Sun, 21 Aug 2022 17:54:55 +0000