watchman device or Xarelto, which would you choose?

I am currently on Xarelto for post ablation partial atrial appendage isolation done 1.5 years ago. While my appendage function has recovered somewhat, it is still at .4 which is not good enough to go off anticoagulation. (needs to be greater than .4). I have had multiple TEE done since the procedure and the appendage dysfunction has not changed and I suspect never will at this point. My electrophysiologist states without anticoagulation I am at the low end of intermediate risk for stroke, hence I am taking the Xarelto. I am fairly young at 56, was previously quite active (marathon runner, although haven't since paroxysmal atrial fib diagnosis). My electrophysiologist is very well versed in Watchman and with his help I have been pre approved for the procedure with my insurance carrier, scheduled for next month.I have been tolerating the Xarelto without any issues. I find myself in a quandry though, as I am balancing the short term risk of the procedure with the long term risk of being on anticoagulation (Xarelto or equivalent) for life otherwise. Just curious, if you were in my position what would you do and what would be your rationale? Much appreciated in advance for any replies.

Damn good question. I'm a year behind you in that decision and my thinking has been to live with the anticoagulants for now, let the science mature, and let the operators get more experience.

It’s late almost midnight and closing eyes but will address your questions as soon as I can redalfa. I would definitely go with the Watchman in your case.

The key is to choose only a truly elite EP Center like St Davids and chose only an elite highly experienced Watchman operator at such a Center. Then you will have high odds of extremely low risks even now and very high odds of getting off OAC .. assuming your systemic stroke risk scores are not above 2.0.

Much more soon!

Shannon

Redalfa,
You and I are the same age so I can def relate. If the anticoagulant isn't a problem you tolerate it well, I'd prob stick with it I'm kinda with Carey on this one. Does the watchman 100% guarntee you will be coagulate free and 100% reduce stroke risks?
Tim

thank you. look forward to hearing more thoughts and opinions

The Watchman will be placed by Dr. Vijay Swarup, who has done more than almost anyone in the country

I was mentally ready for the procedure next month but then stumbled across the article by Dr. John Mondrola in Medscape, who was very negative towards it. The thought of lifelong anticoagulation is very daunting though to me, although now I handle Xarelto without problems. I really don't know what to do. Dr. Swarup is clearly biased in favor of the procedure as he is extremely skilled at it. Any advice is much appreciated.

I will admit I despise taking a daily blood thinner. I bruise so easy and my skin will roll easily when scraped. BUT I am not convinced that the watchman procedure is totally perfected. I do love being in NSR but Xarelto daily stinks. The older I get, The worse the bruising gets. I really have to watch what I do or I dill literally have to wear a long sleeve shirt in the summer months.
One day I will do the Watchmans procedure but it needs more “runtime” for me. I tolerate Xarelto or Eliquis with no issues except bruising.
It’s Hell getting old. Lol. I am 60

Redalafa:

Shannon has a Watchman device, perhaps you could talk to him.

Liz

Quote
redalfa1961
I was mentally ready for the procedure next month but then stumbled across the article by Dr. John Mondrola in Medscape, who was very negative towards it.

Mandrola is negative about everything. It's how he makes a name for himself. His criticisms of LAA closure devices were misguided and poorly grounded in reality.

I am in the same boat also at age 63; in normal rhythm after two Natale ablations, but on Xarelto for now. I'm seeing Dr. Ellis at Vanderbilt for yearly checkup (closer than Austin, TX). He does the Watchman, but doesn't think insurance will cover as long as I am healthy and tolerating Xarelto. So for now looks like I will wait and see what the future holds and keep up with the research and risks of LAA closure vs long term Xarelto use. Keep us posted!

Watchman Device way over Xeralto or any other blood thinner. There is also a newer approach to the left atrial appendage. That is tying it off. Does the same thing as the Watchman Device.