New Guidelines on aspirin use by ACC and AHA

The American College of Cardiology and the American Heart Association just issued new guidelines on the use of aspirin and there are many reports online that give the details.

Sample:

Backing off on aspirin

The ACC/AHA guideline makes clear that aspirin remains life-saving when prescribed following an event such as a heart attack or placement of a stent. But for others, recent evidence shows the risk-benefit analysis tipping away from widespread use of low-dose aspirin due to the potential for bleeding. Doctors should not be prescribing it without a cardiovascular risk assessment, the recommendations say.

Low-dose aspirin (75-100 mg orally daily) might be considered for the primary prevention of ASCVD among those adults 40 to 70 years of age who are at higher risk of ASCVD risk, but not at increased bleeding risk. Low-dose aspirin on a routine basis should not be given to prevent ASCVD among adults once they reach age 70, and it should not be given to any adult with increased bleeding risk.

Bayer released a statement emphasizing aspirin's role in secondary prevention. "For those who have already experienced a heart attack, stroke or other cardiovascular event, discontinuing an aspirin regimen without a doctor’s guidance could increase the risk of another heart attack by 63% and an ischemic stroke by 40%," the statement read in part. "The guidelines do not change the role of aspirin during a suspected heart attack as directed by a doctor."

Reference

Arnett DK, Blumenthal RS, Albert MA, et al, for the Writing Committee. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: Executive Summary. [published March 17, 2019]. J Am Coll Cardiol. doi: [doi.org].


March 18, 2019

New ACC/AHA Guideline for Primary Prevention of CVD Presented at ACC 2019
Brandon May

Excerpt:

Aspirin Use
Based on the level of current data, the guideline recommends against aspirin use among patients aged >70 years as well as adults who are at risk of bleeding. The use of prophylactic aspirin in middle-aged adults is now considered a Class IIb recommendation, the guideline states. “The complexity of assessing risk and benefit related to prophylactic aspirin use in individual patients mandates thorough assessment of cardiovascular risk and bleeding risk and re-emphasizes the importance of shared decision making,” the researchers wrote.
[www.thecardiologyadvisor.com]


American College of Cardiology 2019
[www.ajmc.com]

Each report cautions that if you are currently prescribed aspirin, be sure to review your case and all risk factors with your physician, cardiologist, or EP.

Jackie

Jackie:

Backing off on aspirin

The ACC/AHA guideline makes clear that aspirin remains life-saving when prescribed following an event such as a heart attack or placement of a stent. But for others, recent evidence shows the risk-benefit analysis tipping away from widespread use of low-dose aspirin due to the potential for bleeding. Doctors should not be prescribing it without a cardiovascular risk assessment, the recommendations say.

Oh, they are concerned about bleeding, yet blood thinners are prescribed without a thought as to bleeding. I find this rather strange, one gets knocked down because "oh it causes bleeding", the other all should be taking, doesn't it cause bleeding also? Well, I guess that's alright, aspirin is just too cheap.

Liz

Quote
Elizabeth
Oh, they are concerned about bleeding, yet blood thinners are prescribed without a thought as to bleeding.

That's just not true.

Also, aspirin has a higher bleed risk than anticoagulants. It's not a benign drug.

No Aspirin is not a benign drug and neither is Equilis. Probably most drugs are not benig, they all have some side effects.

L

Liz,
Your suggestion that there is nary a thought given by both the American College of Cardiology & American Heart Association to the bleeding risk of actual Oral Anticoagulants is simply not true! They pay enormous attention to the balance between embolic stroke/TIA risk versus Bleeding risk of these agents ... exactly as they compare the relative potential benefits of a baby aspirin in terms of minimizing embolic stroke/TIA risk versus the well-known bleeding risk of even a baby aspirin.

What the overwhelming consensus of expert opinion earned by numerous well-done studies and RCTs over the last ten plus years clearly shows, is that the relative bleeding risk from prescribing a baby aspirin for the sole purpose of minimizing embolic stroke/TIA risk is more than offset by the very real bleeding risks such patients are exposed to with long-term daily aspirin exposure, in exchange for relatively little embolic risk reduction.

The caveat to this reconfirmed finding is that there is still a modest role for baby aspirin to prevent a second heart attack (MI), though the evidence for prevention of a second MI is not very strong for this potential benefit. And for those who require a metal stent installed in a coronary artery.... at least certainly until said stent(s) are fully endothelialized after which some cardios will stop the aspirin and many just continue it by default, largely from old habits and ‘covering their bases’.

It is not that aspirin has zero benefit here Liz, it’s that the benefit in terms of stroke/TIA reduction is so slight that such a minor potential benefit is significantly outweighed by the more prominent on-going bleeding risk from the continued long term use of aspirin that only increases with age.

And this analysis fully accounts for the fact that, objectively, aspirin poses a relatively modest bleeding risk compared to most true OAC drugs ... except for Eliquis whose claim to fame in the early FDA trials showed roughly equivalent bleeding risk to once a day aspirin and yet offering significantly greater embolic stroke/TIA risk reduction compared to aspirin.

All the OAC drugs are overall more effective in embolic stroke prevention compared to a daily aspirin dose whose Thrombo-embolic (TE) risk reduction is very low. And were it not for the considerable added bleeding risk of most all OAC drugs...including the NOACs (with Eliquis still the least bleeding offender among the NOACs) and Vitamin K-antagonist-based Coumadin derivatives OAC drugs, all have more absolute bleeding risk than does aspirin ... the food and drug lords would no doubt have sprinkled NOACs in all of our Cheerios long ago!

Bottom-line, for the purpose of AFIB-related TE reduction and especially when factoring in the not-insignificant bleeding risk from life-long daily aspirin ... depending on a daily aspirin for TE protection is now officially deemed a dud!

Best,
Shannon



Edited 2 time(s). Last edit at 03/18/2019 06:07PM by Shannon.

Jackie ... After my first heart attack I was prescribed Clopidogrel (Plavix) and Aspirin and promptly developed GI bleeding. The GI bleeding was resolved by taking Pantoprazole (Protonix) which is a stomach antiacid medication similar to the OTC Prilosec. Now on Pantoprazole + Eliquis + Clopidogrel + Dofetilide I have zero stomach issues. LasVegas-Roy

How much aspirin did you take and how do you know it was the aspirin that caused your GI bleeding, you were taking Plavix which also can cause bleeding. My mother was on Coumadin and had bleeding in her GI tract. May I ask why are you on Pantoprazole now since you quit aspirin? Also why are you on 2 blood thinners, seems like overkill.

Liz



Edited 1 time(s). Last edit at 03/18/2019 09:31PM by Elizabeth.

I had asked on another post but haven’t seen an answer:

I had my Watchman procedure 1/31; saw the nurse practitioner on 3/13 and was told to stop Xarelto and start on Clopidogrel (I had already started 81mg aspirin upon discharge along with the Xarelto). I cannot wait to get off the Clopidogrel but can’t see the Dr till 3/24 for a “conversation,” and then a TEE on 3/37. I’m wondering (even before this study came out) why I would take an aspirin every day forever. Maybe that will change?

Liz … I was on 81mg Aspirin but no I can't definitely say it was the sole cause of the GI bleeding but I followed my cardiologist direction and started Pantoprazole which stopped the bleeding. Clopidogrel (Plavix) is an anticoagulant and I took it and continued the Aspirin until I started Eliquis which is a blood thinner. They do different functions. LasVegas-Roy

Not to mince words but Plavix and aspirin are anti-platelet drugs while Eliquis, Xarelto, etc. are anticoagulants.

The important thing to know about the anti-platelet drugs is they render platelets inactive permanently. It takes your body 5-7 days to replace them with new platelets and there is no reversal agent. If you were to experience a serious bleed while on them, the only way to restore your platelet function is by transfusion of plasma or whole blood.

I had a metal stent installed in the circulatory system in Jan. 2012. My Cardiologist is insistent that I continue a 81 mg a day aspirin forever. I am looking for opinions if this is now a necessity.
This small aspirin has caused me to have acid reflux and I take 15 mg Prevacid daily and 75 mg Zantac for “breakthrough acid reflux” which is daily. My Cardiologist would rather me be on reflux meds than stop the 81 mg aspirin.

Is He outdated in his thinking? Aspirin has irritated my stomach liner. I will say that in 2014 Dr. Natale wanted me to continue the acid regimen also. He could have a different opinion now.
I would be ecstatic if I could stop this daily aspirin. I am looking for experienced opinions. Thanksgivings

Louise and smackman,

A stent and a Watchman are metal objects in direct contact with blood flow. Platelets tend to adhere to metal objects and form clots. That's why the aspirin and Plavix. What should happen is both will become endothelialized, or covered with your own tissue, after a period of time (about 6 weeks for Watchman, not sure about stents but probably similar). Once that happens you won't need the aspirin anymore. The trouble is, there's no way to know with certainty if it has happened and if it's complete. So the recommendation to continue aspirin for life is out of an abundance of caution.

Well this is what Dr. Oz says about Aspirin, Dr. Natalie doesn't seem to have too much of a problem with aspirin.

An aspirin a day can block certain chemicals like thromboxane, which is naturally produced to clot blood.

[www.newsmax.com]


Liz



Edited 1 time(s). Last edit at 03/20/2019 08:05PM by Elizabeth.

Quote
Elizabeth
Well this is what Dr. Oz says about Aspirin, Dr. Natalie doesn't seem to have too much of a problem with aspirin.

Dr. Natale does not agree with the standard recommendations. I know because I follow his advice.

As for Dr. Oz, he's a ridiculous TV character and no one should pay attention to him.

Dr. Natale actually told me with my Wife present to take a 325 mg aspirin a day along with my 5 mg 2x a day Eliquis back in 2014 after my 1st Ablation. I changed it to 81 mg in 2016 with my local Cardiologist blessing because of the stomach liner irritation. I had a upper GI ran 2 weeks before and it showed a irritated stomach liner. At that time, I was on a IC diet which is very strict especially with acidic food. IC stands for Intertestial Cystitis.

Dr. Natale was definitely for a aspirin regemin with the Stent I had at that time.

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smackman
Dr. Natale was definitely for a aspirin regemin with the Stent I had at that time.

Aspirin is still recommended for people with stents because it's a metal object in contact with blood flow, and platelets tend to stick to metal objects, so an anti-platelet drug like aspirin will prevent that.

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Carey

Dr. Natale was definitely for a aspirin regemin with the Stent I had at that time.

Aspirin is still recommended for people with stents because it's a metal object in contact with blood flow, and platelets tend to stick to metal objects, so an anti-platelet drug like aspirin will prevent that.

Many on here would question that answer. I have been ask why I am still required to take a baby aspirin because the stent should be endothelialized by now as you stated above in your other comments.
I just do what I am told by my Cardiologist and EP. Aspirin does affect my stomach liner

Quote
smackman
Many on here would question that answer. I have been ask why I am still required to take a baby aspirin because the stent should be endothelialized by now as you stated above in your other comments.
I just do what I am told by my Cardiologist and EP. Aspirin does affect my stomach liner

I was just repeating what the official guidelines say. It's the same for devices like the Watchman. It should be fully endothelialized after a couple of months, but there's no guarantee of that and there's no way to know short of autopsy. Examples of partial endothelialization even after more than a year have been found, so that's why the guidelines call for continuing aspirin.

That said, Natale thinks lifelong aspirin is probably overkill and he offers half-dose Eliquis as an alternative. That's what I'm on 7 months post Watchman even though the FDA guidelines say I should be on aspirin instead. It's entirely possible his views have changed since 2014 regarding stents and he would suggest the same for you now.

Quote
Carey

Many on here would question that answer. I have been ask why I am still required to take a baby aspirin because the stent should be endothelialized by now as you stated above in your other comments.
I just do what I am told by my Cardiologist and EP. Aspirin does affect my stomach liner

I was just repeating what the official guidelines say. It's the same for devices like the Watchman. It should be fully endothelialized after a couple of months, but there's no guarantee of that and there's no way to know short of autopsy. Examples of partial endothelialization even after more than a year have been found, so that's why the guidelines call for continuing aspirin.

That said, Natale thinks lifelong aspirin is probably overkill and he offers half-dose Eliquis as an alternative. That's what I'm on 7 months post Watchman even though the FDA guidelines say I should be on aspirin instead. It's entirely possible his views have changed since 2014 regarding stents and he would suggest the same for you now.

The cost difference between Eliquis and Aspirin is substantial for most individuals. To me, Aspirin would be an easy choice in that situation. Eliquis does have side effects also IMO. That is what I take 2.5 mg 2x a day and it puts me in the donut hole every year. Eliquis is a requirement plus the 81 mg aspirin for the stent.

Yeah, I get it that there's a cost issue, but your problem seems to mainly be the stomach issues caused by aspirin.

Bottom line is it's your decision. Your stent is probably endothelialized and you don't need aspirin or Eliquis, but you don't have any way of knowing if that's true, so it's a gamble. I don't think there are any firm answers.

Quote
Carey
Yeah, I get it that there's a cost issue, but your problem seems to mainly be the stomach issues caused by aspirin.

Bottom line is it's your decision. Your stent is probably endothelialized and you don't need aspirin or Eliquis, but you don't have any way of knowing if that's true, so it's a gamble. I don't think there are any firm answers.

No gambling here but I was under the impression that aspirin and Eliquis serve 2 different purposes so how can Eliquis replace aspirin for a stent? Aspirin is used as a anti platelet whereas Eliquis is a anticoagulant right?

Carey:

Why are you on Eliqus, I thought the purpose of having the Watchman would be that an anticoagulant would no longer be needed?

Liz

Quote
smackman
No gambling here but I was under the impression that aspirin and Eliquis serve 2 different purposes so how can Eliquis replace aspirin for a stent? Aspirin is used as a anti platelet whereas Eliquis is a anticoagulant right?

Right. Aspirin is better at preventing platelets from sticking to foreign objects, but if they do begin to stick, Eliquis will prevent it from enlarging and forming a clot that could break off and cause trouble. Since your stent and my Watchman are almost certainly endothelialized by now, we probably don't actually need either one, so continuing aspirin or low-dose Eliquis is just an insurance policy against the rare chance of incomplete endothelialization.

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Elizabeth
Why are you on Eliqus, I thought the purpose of having the Watchman would be that an anticoagulant would no longer be needed?

See my answer to smackman. At this point I could stop the Eliquis and take nothing at all. Natale agrees that's a very low risk decision and I'm free to make it. However, out of an abundance of caution I'm continuing it at least until August. In August they're going to do a repeat TEE as part of the study, and if that TEE shows that no device related thrombus has formed, I will probably stop the Eliquis then.

I really wasn’t aware that the Watchman had any metal on it. Isn’t the purpose of the follow-up TEE to ensure my own tissue has grown over it? Are you saying that sometime, even a few years from now it could “break through?” This procedure isn’t doing anything for my AFIB or heart rate — the absolute only reason I had it done was to go off blood thinners. I’m sure Dr. Doshi will tell me to just continue with the low dose aspirin, which is fine with me; but Carey’s “insurance policy” raises questions.

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Louise
I really wasn’t aware that the Watchman had any metal on it. Isn’t the purpose of the follow-up TEE to ensure my own tissue has grown over it? Are you saying that sometime, even a few years from now it could “break through?” This procedure isn’t doing anything for my AFIB or heart rate — the absolute only reason I had it done was to go off blood thinners. I’m sure Dr. Doshi will tell me to just continue with the low dose aspirin, which is fine with me; but Carey’s “insurance policy” raises questions.

I'm sorry if I misled you. The Watchman has a small metal nut in the middle of it that the catheter screws into. That's how they hold it on the end of a catheter. The rest of it is a mesh fabric material that platelets don't cling to.

No, there's no danger of any sort of "break through" occurring now or in the future.

The insurance policy I've been talking about is just an alternative to the same "insurance policy" that the official guidelines call for by saying you should take aspirin. I haven't said anything that's a new risk previously unknown to you or anyone else. I'm sorry if I misled you into thinking otherwise.

Here are the two things I've tried to convey:

1) The official FDA recommendation is to continue aspirin for life after a Watchman.

2) Some EPs believe that's overkill and not necessary. But if you want to be absolutely sure, a low dose of an anticoagulant is an equally effective and safer choice.

Liz,

look into garlic and fish oil.
I understand garlic is simular to aspirin.

Below is from Hans book
"Garlic, in many ways, acts similarly to aspirin."

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Carey
Here are the two things I've tried to convey:

1) The official FDA recommendation is to continue aspirin for life after a Watchman.

2) Some EPs believe that's overkill and not necessary. But if you want to be absolutely sure, a low dose of an anticoagulant is an equally effective and safer choice.

Thanks, Cary. This is very helpful.I find myself wondering if there's a significant difference between an anti-platelet agent and an anticoagulant, or at least how they act differently, in terms of preventing platelets clinging to devices and forming device related thrombi/clots.

--Lance

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ln108
Thanks, Cary. This is very helpful.I find myself wondering if there's a significant difference between an anti-platelet agent and an anticoagulant, or at least how they act differently, in terms of preventing platelets clinging to devices and forming device related thrombi/clots.

Anti-platelet drugs like aspirin and Plavix render platelets inactive. Basically, it kills them and they cease to function until your body makes new ones, which takes 5-7 days. It can't be undone by taking a reversal agent. That's one of the reasons why aspirin isn't the safer alternative people like to think it is. The only way to reverse aspirin is with a transfusion of plasma or whole blood, which is a big deal with its own risks.

The anticoagulants don't harm platelets. Instead, they interfere with other chemical reactions that make up what's known as the clotting cascade in order to prevent clots from forming (or enlarging if they're already formed). The clotting cascade is ridiculously complex and I'm not even going to attempt to explain it. Just google it and you'll see what I mean.

In practical terms, what this means is aspirin will prevent platelets from sticking to the metal parts of an implanted device such as that little nut in the center of a Watchman or a stent in an artery. That's why they have you take aspirin after receiving a Watchman or stent. Anticoagulants won't prevent that from happening, but it will prevent any platelets that stick to it from enlarging into a clot that could be dangerous. The only reason the FDA protocol has people continue aspirin for life is out of an overabundance of caution to protect against the rare possibility that endothelialization will be incomplete and that bit of metal might remain exposed to blood flow. I think with time and more experience with the device that recommendation will eventually go away.

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Carey
. . . aspirin will prevent platelets from sticking to the metal parts of an implanted device such as that little nut in the center of a Watchman or a stent in an artery. That's why they have you take aspirin after receiving a Watchman or stent.

Thanks, Carey. Very clear explanation, as usual. One further question, if I may: Am I right that the new Watchman FLX thati's still in trial doesn't have that "little nut," or at least, that the nut has been recessed and/or covered with mesh so that it's no longer, or less, of an issue?

--Lance

With the FLX it's still there, but as you mentioned it's recessed so it's not sticking out in the blood flow and it should be easier for endolialization to grow over it. We won't know until the trials are complete and the data published, but it's hoped that will reduce the incidence of device related clots.

For those of us on Apixaban (Eliquis) there is good news coming although when exactly they will be available is not clear as I've seen some indications it will be in 2019 but others not so fast. LasVegas-Roy

Mumbai, Baltimore, December 10, 2018: Pharma major Lupin announced that it has received tentative approval for its Apixaban Tablets, 2.5 mg and 5 mg from the United States Food and Drug Administration (FDA) to market a generic version of Bristol-Myers Squibb Company's Eliquis® Tablets, 2.5 mg and 5 mg.

Full Link: [www.lupinpharmaceuticals.com]

In a bit of a quandary about aspirin usage.

Had a Natale ablation in March 2011 for proxamol arrhythmia with no issues since. Only medication recommended by Natale at the time was 325 mg aspirin.

In 2017 had a checkup with local cardiologist and based on my CHAD score of 2 (age and blood pressure medication) recommended that I begin anti-coagulant medication. I was very hesitant and attempted to get an opinion from Natale but due to the length of time post ablation an opinion via phone was not an option but required an office visit. Saw him in March of last year........anticoagulant medication was definitely not required but did recommend that I switch to 81 mg aspirin.

Based on what I have read here about the risk/benefit of any aspirin for a 70+ year old I am trying to decide if I should stop the aspirin. But I wonder why Natale would recommend the usage????


Steve
Sp[ring, Tx.

Jayhawk:

I would go with what Dr. Natalie said.

Liz

If anti-platelets are effective for 5-7 days, why take them every day? There is absolutely nothing to reverse this should you have a bleeding injury.

I’m with a Elizabeth for natural remedies. I take lots of fish oil, vitamin c, vitamin B6 and am adding Vitamin E. In Hans’ latest book, he says:

“...two large studies carried out at the Harvard Medical School concluded that people who had taken 100 IU of Vitamin E for two years or more had a 30% lower incidence of ischemic stroke — this is equal or better than the protection offered by aspirin. Fish oils, Vitamin C, Vitamin B6, and garlic also inhibit aggregation and have been associated with relative risk reduction for ischemic stroke in the general population of 40-60%. (Pages 69-70.)

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Louise
If anti-platelets are effective for 5-7 days, why take them every day? There is absolutely nothing to reverse this should you have a bleeding injury.

Because your body is making new platelets all day, every day, so it's a continuous process. Taking it daily is how you maintain a steady state. If you did otherwise, you'd be doing a roller coaster up and down.

Natural replacements are fine, but do you know if vitamin E etc. prevent platelets from sticking to foreign objects? And do you know if they do so as effectively as aspirin? I don't, and with an implanted device in my heart I'm not willing to become a clinical trial of one person to find out.

Aspirin CAN be reversed. As I said above, it requires a transfusion of whole blood or plasma. Can natural blood thinners be reversed? Who knows....

I wasn’t told by my doctor that the reason for aspirin was to keep platelets from sticking to the Watchman device. I thought aspirin was just a “mild blood thinner.” It’s only reading the various posts here that I’m wary of aspirin and internal bleeding (which is why I had the Watchman in the first place — because I feared internal bleeding from anticoagulants.). Also, I will be 70 in June. So I feel like I’m an experiment either way. I’m not trying to argue with anyone here — it just seems like this surgery may not have been necessary, nor providing the outcome I wanted. Since the Watchman prevents strokes, I may go back to Cardiokinase, which is all I took for the entire year of 2017. I just really, really don’t want internal bleeding. Right now, taking Plavix AND aspirin seems like a very bad idea. Oh, and also I had asked about stopping aspirin before oral surgery and I think I read 5 days before or maybe not at all. I’m probably dense, but it all seems very conflicted. And now with the new aspirin report.....

One more thing,

Quote: What should happen is both will become endothelialized, or covered with your own tissue, after a period of time (about 6 weeks for Watchman, not sure about stents but probably similar). Once that happens you won't need the aspirin anymore. The trouble is, there's no way to know with certainty if it has happened and if it's complete. So the recommendation to continue aspirin for life is out of an abundance of caution

When you say there is no way to know if the Watchman is endothelialized, isn’t that what the follow up TEE is for? You say once that happens you won’t need the aspirin anymore. So the TEE will not show if it has happened? This is one of the conflicting things I don’t understand.

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Louise
When you say there is no way to know if the Watchman is endothelialized, isn’t that what the follow up TEE is for? You say once that happens you won’t need the aspirin anymore. So the TEE will not show if it has happened? This is one of the conflicting things I don’t understand.

Unfortunately, no, a TEE can't detect if the device has been fully endothelialized. The TEE is to ensure that the device remains properly placed, that it has no leaks, and that there are no clots attached to it. It can provide a hint whether endothelialization has occurred by showing a lack of turbulence over the device, but it can't provide proof. There is no test or imaging method that can.

The bottom line is we have to trust that the device is doing what it was designed to do and so far has proved successful at doing. I'm in the same boat and I'm going to have a final TEE at the one-year point in August. If that TEE shows everything is fine, I'm going to stop my half dose of Eliquis. The track record for the device going back a number of years says that's a safe thing to do.

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Louise
I wasn’t told by my doctor that the reason for aspirin was to keep platelets from sticking to the Watchman device. I thought aspirin was just a “mild blood thinner.” It’s only reading the various posts here that I’m wary of aspirin and internal bleeding (which is why I had the Watchman in the first place — because I feared internal bleeding from anticoagulants.). Also, I will be 70 in June. So I feel like I’m an experiment either way. I’m not trying to argue with anyone here — it just seems like this surgery may not have been necessary, nor providing the outcome I wanted. Since the Watchman prevents strokes, I may go back to Cardiokinase, which is all I took for the entire year of 2017. I just really, really don’t want internal bleeding. Right now, taking Plavix AND aspirin seems like a very bad idea. Oh, and also I had asked about stopping aspirin before oral surgery and I think I read 5 days before or maybe not at all. I’m probably dense, but it all seems very conflicted. And now with the new aspirin report.....

No, aspirin isn't a "mild blood thinner." It is specifically an anti-platelet drug used specifically to prevent platelets from sticking to the device. At least in the first six months, it's very important to take it for that reason.

When was your Watchman implanted? The combination of Plavix and aspirin should only be for six months. After that you should stop the Plavix and take only aspirin according to the FDA recommendations. However, not everyone believes the FDA recommendations are the right thing to do. Many knowledgeable EPs in this field think they're overkill. As long as you're past the six-month point, I'm not going to tell you that stopping aspirin is a terrible idea. It's your decision and there are many people out there with Watchman devices who take nothing at all. In August, I may become one of them myself.

Carey, I had mywatchman put in January 31. I have the follow up TEE on May 27. I am taking aspirin and Plavix right now. It’s only after reading the latest report on aspirin and all of the posts here that I’m nervous about taking them both. It seems the possibility of bleeding is worse than Xarelto. Also, like Xarelto, there is no antidote if I have an injury that causes bleeding. When I saw the nurse practitioner on March 13, that’s when she told me to stop the Xarelto and take the Plavix instead along with the aspirin (which I have been taking since I left the hospital along with the Xarelto.). She said I should take the Plavix for 6 weeks, not months.

Also, just to clarify, can’t the Dr. see if the tissue has covered the device during the upcoming TEE? In an earlier post I believe you said once it is covered there isn’t a chance that the device could “break through,” eliminating the possibility of platelets sticking to it.

Thank you for all your information and patience with all my questions. I believe my Dr. may have over simplified it and I didn’t ask all the right questions — I was so excited about going off blood thinners!