Just got back from TEE, which was to follow up on Watchman implant January 31. There is a small clot on the device and the Dr put me back on Xarelto for 30 days, when I will have another TEE to make sure the clot is gone. I had been on Xarelto for 45 days after initial procedure along with 81mg aspirin. He replaced the Xarelto with Plavix for another 6 weeks.

I didn’t know Xarelto dissolved clots. I’m wondering why the clot formed in the first place. Of course I never saw the Dr today — he was only in the room while I was “out.” I admit to missing a dose of aspirin once in awhile.

Xarelto doesn't dissolve clots. None of the anticoagulants dissolve clots. What it does is prevent the clot from enlarging or new ones forming. Your body will then dissolve the clot on its own.

Clots tend to form on any artificial substance that's exposed to blood flow, especially metal. That's because platelets tend to stick to foreign objects, which is why you're given aspirin and an anticoagulant for the first 45 days. Aspirin disables platelets. Plavix is also an anti-platelet drug. What should happen during those 45 days is your own tissue grows over the Watchman, covering it, and therefore protecting it from direct contact with blood flow. This is a process known as endothelialization. However, in rare cases the endothelialization isn't complete by 45 days and some of the Watchman is still exposed. That's apparently what happened in your case. So the strategy now is to prevent the clot from enlarging while your body dissolves it and hopefully the endothelialization becomes complete so this doesn't happen again.

Don't miss doses of anything from here on out. Not even one. Get a pill minder that lets you know when a dose is due, or do what I do and set an alarm on your phone to go off when things are due.



Edited 1 time(s). Last edit at 05/25/2019 02:56PM by Carey.

Thank you Carey. What if the clot breaks free from the metal?

Then that clot will go somewhere. It could be your brain, your liver, or your big toe. No way to predict.

In general, it wouldn't be good, but the odds of it breaking free are low. So just be religious about the drugs and you'll probably come out of this just fine. :-)

Naive q here. Went wouldn't they use a clot buster drug to get rid if this?

Thank you, Brian — I’ve never heard of a “clot buster” drug, but if there is one I’m anxious to hear the responses!

Good luck Louise,

I know that must be anxiety inducing, but I've read that in time and as long as you religiously follow your regimen, all should resolve in your favor.

I agree with a daily alarm on a phone every 12 hours. I also purchased and carry a small, watertight container for my key ring that holds a dose of every med I take. It's saved me on more than one occasion.

Thank you, AB. I take all of my supplements meds at the same time with meals every day. I may have missed a couple of doses of aspirin because I chew it separately, usually when I first wake up. I’m not sure that was the cause, because it would have been rare, and I was also on Xarelto for the first 6 weeks and then on Plavix for the next six weeks along with the aspirin. Of course this scare will prompt me to NEVER miss the aspirin!

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Brian_og
Naive q here. Went wouldn't they use a clot buster drug to get rid if this?

No. The drug you're thinking of is called tissue plasminogen activator (tPA), and it's used only in the first three hours after a stroke. It comes with a big risk of causing bleeding in the brain, it's only administered IV, and it's ridiculously expensive. It would be far too risky to use in a situation like this where there's no immediate danger.

I have a question (not urgent) about the anesthesia. When I had my Watchman procedure I know they used Propofol and that was fine. I had very little, if any after effects. Yesterday the Anesthesiologist asked me if I was okay with the “drug they used last time,” and I said yes. He then told me he was going to use another drug. I cannot remember it, but it started with Ma.... I came home and slept, got up for dinner and TV, went to sleep by 9:30 and slept till 5:30. I got up, had coffee and breakfast and brushed my teeth. I was going to get dressed and suddenly felt very lethargic and have been reading/dosing off since.

Is it possible that it is still in my system? The procedure was much less invasive and only took less than 30 minutes; so it couldn’t have been that much of a shock to my body. Not sure why he asked about the last one and then used a different one. Not concerned, just curious.

Does midazolam sound right?

If that's what it was, pretty unlikely it would have effects the next day because it has a very short half-life (3 hours). But according to drugs.com, it can be prolonged in cirrhosis, congestive heart failure, obesity, renal failure, and the elderly. They don't say what they mean by prolonged but if any of those things apply to you it's possible.

Thank you, Carey. I’ll be 70 next month, but I don’t consider that (or me) elderly. Nothing else applies. Maybe just tired from the stress of the found clot and another TEE in a month.😊

By the way, one thing I forgot to mention is that you have to take Xarelto with food. Not taking it with a meal significantly reduces its effectiveness.

Thank you, Carey. Yes, I always take mine at dinner time.

Louise, evidence indicates that nattokinase will dissolve blood clots.

Nattokinase Antithrombic Agent

More Pub Med information is available here:

Search: Nattokinase Dissolve Blood Clots

This may mean juggling more than you really want to, but at least you have the information.

Jim, thank you! Actually I’m a huge fan of Cardiokinase and took it exclusively for all of 2017 because Xarelto was so expensive. I have Hans’ latest book, which is “paper clipped” on many pages. I wish now I had been taking it since my Watchman procedure but thought it was overkill. I am now taking it again and will probably take it or Nattokinase along with aspirin the rest of my life!

Louise, Propofol has less hang over effect than does midazolam (also known as Versed) which is a hypnotic with pronounced short-term amnesiac effects ... “So hey ... even if the patient is hurting or feel anxious during the procedure, if don’t recall anything, who is going to complain?? Or so the logic goes :-)

If you need any more such procedures I suggest making a strong request for Propofol, it is highly effective and very clean afterward and you tend to be calm and clear not long after you wake up. Provided they don’t also load you up with a bunch of other drugs like Midazolam, Fentanyl and/or a bunch of other Class III Anesthetic drugs after inducing anesthesia with propofol.

The type of clots that only very infrequently form on a less than fully endothelial-ized WATCHMAN is very unlikely to result in an embolic event in any case. Much less so a full blown major stroke. Usually there are no consequence reported, though a few TIA have been noted very occasionally.

Shannon



Edited 1 time(s). Last edit at 05/26/2019 01:57AM by Shannon.

Shannon, thank you so much for your, always, good information. I’m sure what I was given will show up in my TEE report. I will have to have another in 30 days or so and I will definitely request Propofol. A TEE is a quite short procedure so I don’t know why I would be “drugged up.”

I appreciate the facts from you and Carey about the clot — it was certainly disconcerting but the “hangover” intensified it. I’m quite sure with Xarelto, aspirin and Cardiokinase I will be fine until it dissolves, hopefully by the next TEE. I’m so grateful for all your educated information! Louise