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Carey



That is the main reason, and you probably heard strokes sometimes being worse than death from me because I like to remind people of that. But keep in mind there are two types of strokes: Embolic strokes, which are usually caused by blood clots and are the type we with afib worry about, but there are also hemorrhagic strokes, which are caused by bleeding in the brain. Brain bleeds happen for many reasons and they're usually unpredictable, but when one does occur, being on an anticoagulant is not a good thing. It can change a minor stroke into a major one.

So my point is simply that you can't ignore the bleed risk side of the equation. I have a Watchman and take a half dose Eliquis instead of full dose for exactly this reason.




Carey, thank you for differentiating the 2 types of strokes. For the reason you stated, I am going to stay on the half dose Eliquis.

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JakeL
Your other point that Eliquis has a bleed risk is certainly important, but I have not heard much about it here. What I have heard is the the main reason for taking the anticoagulant is to minimize stroke risk (heard on this board is that stroke can be worse than death). So, avoiding stroke should be the primary reason for making a decision about what option to take.

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JakeL

The question that needs to be answered is -- Which option below reduces the risk of stroke the most:

1. Full dose of Eliquis per day
2. Watchman procedure and 1/2 dose of Eliquis per day
3. Watchman procedure and full dose of Eliquis per day
4. Watchman procedure alone


Given all of these considerations, I would opt to go with option #3, Watchman and full dose of Eliquis. Should we take a poll?

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JakeL
The question that needs to be answered is -- Which option below reduces the risk of stroke the most:

1. Full dose of Eliquis per day
2. Watchman procedure and 1/2 dose of Eliquis per day
3. Watchman procedure and full dose of Eliquis per day
4. Watchman procedure alone

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GeorgeN

So having a clot while on half dose is possible. I had to take BID heparin shots for 6 weeks and now I am instructed to take full dose Eliquis for life because half dose didn’t dissolve the clot.

I don't believe Eliquis, or warfarin or other NOAC blood thinners, will dissolve clots. They can reduce the risk of having them. Body functions can dissolve clots.

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susan.d
So having a clot while on half dose is possible. I had to take BID heparin shots for 6 weeks and now I am instructed to take full dose Eliquis for life because half dose didn’t dissolve the clot.

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susan.d
So having a clot while on half dose is possible. I had to take BID heparin shots for 6 weeks and now I am instructed to take full dose Eliquis for life because half dose didn’t dissolve the clot.

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G48
I just got off the phone with Shannon having a preop phone call regarding my 2nd ablation and watchman implant on 8-21 and I queried her about the watchman blood clot protocol. She advised me that the way Dr Natale handles the follow-ups is as follows: 2 months after the implant, the patient will be physically present at St. David's for a TEE. At 6 months, 1 year, and 2 year marks after the implant (total of 4) a CT scan with contrast can be performed by a local hospital with specific instructions from Austin on how to perform the scan. This is instead of doing the next 3 scans at St. David's if you are not local or willing to travel. I mentioned your situation and she asked for your name but I could not gather it from your profile. I do have her email if you would like to reach out to her.

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Carey
If memory serves correctly, they've only seen the DRTs (device-related thrombi) with people who stayed on aspirin rather than low-dose Eliquis and those are the only people they're recommending get a 2-year scan.

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Pixie
I hope we can get this straightened. Carey, if you read this, am I in my “overthinking” mode?😧

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AB Page
I had a recent Telemed and asked Shannon about this. I am one who has been on low dose aspirin almost exclusively after the 45 day period, back in ...'18? There was a several month time frame where I did the low dose Eliquis, then he had me switch to low dose aspirin. I've never received a clear to me answer as why. Shannon said the choice to be imaged is completely up to me, but she made it very clear that the percentage of folks with a thrombus are extremely small. I had no leaks after implantation, and while I have debated going to Austin for the imaging (because I love Austin), I'm still mulling it over, and may book a trip when it cools down. Shannon also stated that even a massive thrombus would be asymptomatic, unless that bad boy breaks loose. Beyond me how a massive clot can be in their and you not feel any adverse effects.

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Daisy

Yes, I was told that he was doing a final 2 year scan in a consult I had with him about 6 months ago, but I haven’t discussed it with him or Shannon since. I will ask about it on my next consult. If he has seen a few clots, it seems like a good precaution.[/quote


Daisy,
My 1 year CT was fine. I would not have known he recommended a 2 year CT until I saw your post about that a month or so ago. I know I told you that I asked Dr. Natale about this when I had a telehealth visit and he said it applies to folks who chose to take aspirin rather than stay on the half dose Eliquis. Then I heard that you knew of folks who were on Eliquis and he recommended they get one also. I really just want to know what criteria he is using to decide who should get that. My 2 year post watchman is the end of September. It is unusual for me not to hear back from Shannon. Do you know, Daisy, who else I could reach out to?

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Pixie
I read on this forum that because a few people have developed blood clots a year after their watchman implant, Dr. Natale is recommending a CT scan at the 2 year mark. Since I am approaching 2 years post watchman, I reached out twice to his office to see what the protocol is and who it applies to. I am getting no response, so I am asking any Dr. Natale folks on this forum if they have been contacted and are being told anything about this. I am finding this quite frustrating.