LAA Xarelto and Hematomas

Somewhat similar post to others regarding LAA isolation and LAA closure-
I've had 2 Natale ablations, the last isolating the LAA. I had some minor afib break through about a year ago and is controlled with Multaq.
I'm age 66 and in pretty good health. My recent issues started with a fall I took while running and I landed on my fist which cause a contusion and massive hematoma in my thigh/quad. Because of the Xarelto, a fairly minor issue turned into a big one that took about 2 months to rehab. Then a couple weeks ago I had a new hematoma arise without a certain cause in the same leg in a different location. Again, Xarelto causing the hematoma to be a much bigger issue. I'm still recovering from this one.
I have not contacted Dr. Natale because Dr. Christopher Ellis at Vanderbilt has been taking care of my annual EP visits since he is much closer. After these bleeding incidents I inquired about whether these intramuscular bleeds/hematomas might qualify me for a Watchman. It seems I either need to get off Xarelto, or become a much less active person. Plus I now wonder about the Xarelto preventing one type of stroke but causing a hemorrhagic stroke after these experiences with hematomas.
I hate the thought of being on Xarelto the rest of my life. It seems I've been in too good of health to qualify for a Watchman or other closure procedure, but maybe these recent events might tip the scale.
I'm currently on Anthem insurance via my employer but may retire soon and will be on Medicare.
Dr. Ellis recommended doing a touch up ablation and while there testing the LAA function to see if any function has returned, then go from there. Previously he had mentioned possibly doing a hybrid ablation and doing the Lariet or Artriclip. I would prefer to try to get everything done at one time, address the break through afib and closing the LAA so I can get off Xarelto since it is, in my opinion, becoming intolerable due to the intramuscular bleeds I have had. Is that realistic?
Any thoughts or words of wisdom?

Tough problem you've got there, but I think you're in good hands with Ellis. Doing a Lariat or AtriClip along with a touch-up ablation makes sense, but keep in mind it's surgery, so it's going to be much longer recovery than just an ablation.

Hi ken you are sorta in my league. I too had a Natale ablation 8/6 LAA isolated. On eliquis til such time im either arrhythmia free and LAA pumping 60% or im not. So 2 cans of worms only time will tell. Im 5 weeks post ablation tomorrow. Had a virtual with my charlotte EP yesterday. He supported my trip to Natale. Hes i think still in conservative camp on LAA isolation but actually im not. If it stops most arrhythmias and you can get a Watchman then wow! Dr Holshouser said: i did a Watchman yesterday! Its alot easier than an afib ablation. I asked dumbly about just removing LAA. But thats surgery. I too am active and going forward dont wanna be on eliquis for years. Im not a biker runner or high risk sports guy. Im weights walking staionary biker. Low impact. Ive read that in 5 yrs a Watchman is cheaper than eliquis! You and i should be medicare covered. Good luck

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KenKY
I would prefer to try to get everything done at one time, address the break through afib and closing the LAA

[a-fib.com]

LAA Functions Like a Pressure Release Valve
Also, the LAA functions like a reservoir or decompression chamber or a surge tank on a hot water heater to prevent surges of blood in the left atrium when the mitral valve is closed.4 Without it, there is increased pressure on the pulmonary veins and left atrium which might possibly lead to heart problems later.

Losing the LAA Reduces Blood Pumped by the Heart
Cutting out or stapling shut the LAA also reduces the amount of blood pumped by the heart and may result in exercise intolerance for people with an active life style. (In dogs the LAA provides 17.2% volume of blood pumped.5) This is usually not a problem for patients with Persistent (Chronic) A-Fib, whose LAA has stopped contracting along with the fibrillating atrium. Cutting out or stapling shut the LAA won’t affect their cardiac output.

But this may not be the case for patients with Paroxysmal A-Fib who still have large amounts of normal rhythm and whose LAA still functions normally.

But would a non-functioning LAA return to normal when someone with, for example, longstanding persistent (Chronic) A-Fib becomes A-Fib free?

I’m not aware of any surgeons (or EPs) who do pre- and post-LAA closure measurements of exercise ability, heart pumping function, etc. with and without the LAA.

Losing the LAA May Worsen Blood Pressure
The LAA also has a high concentration of Atrial Natriuretic Factor (ANF) granules which help to reduce blood pressure.6 Some preliminary research indicates that when the LAA is closed or cut off, the Right Atrial Appendage produces more ANF to compensate for the lost of the LAA.

Ok now totally confused. Does all the above apply to LAA isolation then a Watchman which people here have done? And i hope to do
Is a Watchman the same as a Lariat. A closure? Thus creating other issues. I cannot imagine it does or the Watchman wouldnt be too popular

The above refers to closure such as sutures, stapler or the AtriClip or Lariat as examples. It different than a watchman which is less invasive.



Edited 1 time(s). Last edit at 09/09/2021 04:13PM by susan.d.

Ok great thats what i kinda figured!

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susan.d
Losing the LAA May Worsen Blood Pressure
The LAA also has a high concentration of Atrial Natriuretic Factor (ANF) granules which help to reduce blood pressure.6 Some preliminary research indicates that when the LAA is closed or cut off, the Right Atrial Appendage produces more ANF to compensate for the lost of the LAA.

That article is decidedly negative and not really accurate. It focuses almost solely on theoretical problems with LAA closure/removal without providing the other side of the coin. I think it's a rather lazy article he probably jotted off in 20 minutes. I'd love to address all his points in detail but I have limited time so I'll just comment on the BP aspect:

The RAA is more than capable of producing all the ANP you need, so saying that it may worsen blood pressure is simply wrong. That's speculation based on an incomplete understanding.

why would Afib-com publish it then? It's not a YouTube source.

Footnote Citations
Damiano, Jr., RJ. “What Is the Best Way to Surgically Eliminate the Left Atrial Appendage?” Journal of the American College of Cardiology 2008, Sept. 9; Vol. 52, No. 11:930-1.↵
AtriCure’s AtriClip system receives FDA 510(k) clearance (press release). June 14, 2010. ↵
Ibid.↵
Al-Saady, N M, et al. Left atrial appendage: structure, function, and role in thromboembolism↵
Hondo T. et al. “The Role of the left atrial appendage. A volume loading study in open-chest dogs.” Jpn Heart J 1995 Mar;36(2):225-34. [www.ncbi.nlm.nih.gov]↵
Atrial natriuretic peptide. Wikipedia.org. Last accessed April 13, 2014, URL: [en.wikipedia.org].↵

Thanks everyone! It seems things are proceeding with doing a touch up ablation and Watchman at Vanderbilt with Dr. Ellis. It hasn't been scheduled yet- nor insurance approval finalized. I will make a post when things are more finalized.

Having a Watchman doesn’t necessarily guarantee coming off a blood thinner or does it??

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walt
Having a Watchman doesn’t necessarily guarantee coming off a blood thinner or does it??

No, it does not.

There are many reasons why it might not but they're all patient-specific. For example, if you have a high CHADS-Vasc score, your risk of clots from other sources may be too high for you to stop. Or maybe you have valve issues, or peripheral vascular disease so you're prone to forming clots in your legs, or a dozen other possibilities.

But if you have a fairly low CHADS score and afib is your only risk factor for blood clots, then a Watchman will allow you to come off anticoagulants.

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susan.d
why would Afib-com publish it then? It's not a YouTube source.

No, but it's only one guy's opinions. It may not be a youtube source but it's also not a peer reviewed journal. It's just his personal web site where he gets to write whatever he wants, and I disagree with pretty much everything he wrote in that article. As I said, I think it was lazy and poorly researched. His references are decades old, which makes them largely irrelevant in this arena.

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Carey

Having a Watchman doesn’t necessarily guarantee coming off a blood thinner or does it??

No, it does not.

There are many reasons why it might not but they're all patient-specific. For example, if you have a high CHADS-Vasc score, your risk of clots from other sources may be too high for you to stop. Or maybe you have valve issues, or peripheral vascular disease so you're prone to forming clots in your legs, or a dozen other possibilities.

But if you have a fairly low CHADS score and afib is your only risk factor for blood clots, then a Watchman will allow you to come off anticoagulants.

Thanks for the info. I am one who would desperately line to get off eliquis so that I can use nsaid medications to deal with other inflammatory issues. Your response suggests, in my case, that would likely never happen. Bummer! Taking into consideration your response, is there any general statistical information related to the percentage of individuals on an anticoagulant who come off the anticoagulant after a watchman procedure? Apologies if I am taking this thread too far afield.

Not too far afield but I don't know what in my response makes you think it would likely never happen for you, so I can't respond to that.

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Carey
Not too far afield but I don't know what in my response makes you think it would likely never happen for you, so I can't respond to that.

Have had a TIA and have a couple leaky valves. So, I’m thinking that may put me outside the box.

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walt
Have had a TIA and have a couple leaky valves. So, I’m thinking that may put me outside the box.

I'm afraid it might. Way above my pay grade to say yes or no, but a prior TIA and valve issues make coming off an anticoagulant difficult.

Keep in mind that you can take NSAIDs while on an anticoagulant, just not for prolonged periods. The general advice I've heard is one week. So you could probably do something like taking NSAIDs for a week, then stop for a week or two, then do another week. Obviously, you need some medical guidance on this but wouldn't one week out of three at least give you some relief?

The Natale group gave me clearance to use ibuprofen for 5 days at 4-6 a day at week 3 post ablation when i hurt my shoulder
I decided not to and took collagen and glucosamine and hyra acid instead. But it was deemed safe over the short term. I just went the total safe rout

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Carey

Have had a TIA and have a couple leaky valves. So, I’m thinking that may put me outside the box.

I'm afraid it might. Way above my pay grade to say yes or no, but a prior TIA and valve issues make coming off an anticoagulant difficult.

Keep in mind that you can take NSAIDs while on an anticoagulant, just not for prolonged periods. The general advice I've heard is one week. So you could probably do something like taking NSAIDs for a week, then stop for a week or two, then do another week. Obviously, you need some medical guidance on this but wouldn't one week out of three at least give you some relief?

Thanks for the reply. I have taken an aleve intermittently for a day or two as needed and have had differing opinions from the two EP’s I have had. One said Nada the other that a couple days here and there presents minimal risk. Saying that taking an Aleve helps give me my life back is probably a bit dramatic but not overly so. Funny, but I have had more knee, hip, shoulder, and spinal injections than I can count and I don’t think any of them have done more for me than a single tab of Aleve. Go figure. I was hoping the watchman would be a solution but the more I learn the more it seems that I am just stuck with myself. Good luck to all the fibbers out there who may be in more distress than me.