New thinking on OAC after Watchman (thoughts?)

[www.tctmd.com]

I read the article last week. I had 2 ablation (2013 and 2015 with Dr. N) with excellent results, so, I'm on Eliquis 5mg twice a day. I was thinking about doing the watchman but the only thing that will change is Eliquis 2,5mg twice a day for life ???
So, is there a real benefit doing the Watchman ?

Im a bit confused too? Its always been watchman, 45 days of OAC , TEE if sealed then Plavix and aspirin for 6 months then aspirin. Now it seems they may ditch the plavix but not sure on length of OAC 1/2 dose. Maybe its 6 months then 81 aspirin?? Did you have LAA isolated?

The decision on what to do after the 6 month period isn't a simple one. The easiest answer and the one often used in Europe is... do nothing. There isn't good evidence that a Watchman needs anything at all after the initial 6-month period. In almost all cases, your body grows tissue over the device, completely sealing it away from the blood flow, so it's impossible for it to cause the device related thrombi (DRT) the article discusses.

Fear of DRTs are what the FDA protocol of aspirin-for-life is based on, but that fear isn't based on science. It's based on "but what if...."

And keep in mind that the article was focusing on the short-term following implantation, within the first year. It didn't really address lifelong issues.

That said, I've had a Watchman for 3 years now and I take 1/2 dose Eliquis by choice based on Natale's advice, my own research, and the concurrence of my PCP and local EP. The reasons I take it actually have nothing to do with the Watchman. I don't believe I need to take anything for the Watchman. I simply believe 1/2-dose Eliquis is safer and more effective than aspirin as a daily prophylactic, and since I have mild aortic plaque (like damn near everyone on this forum over the age of 60), that means I have an increased risk of clots from sources other than the left atrium. A recent study widely reported in the press on daily aspirin use strongly suggests I made the right choice.

So I don't think that article is as confounding as it seems on the surface. They're just discussing whether aspirin or 1/2-dose Eliquis is better during the initial follow-up period. After that is a whole different question, and I strongly suspect the data will eventually show you don't need to take anything after the first 6-12 months.

Perfect thanks Carey. Yes ive seen aspirin falling outa favor. My ep had me on 2 325 s prior to my 2012,ablation lol

Yes, LAA isolated. I will wait another 5-6 years with full dose and see what are the new numbers then to decide if I do the Watchman or not.