Why the need to wait 6 months after Watchman implant?

Just a question I've had. I had the Watchman implant on January 11th, 2022, and then my follow up TEE 6 weeks later. All looked good per Dr. Natale, and no need to do any "touch up" ablating.

Why then do I still need to stay on the blood thinners (Eliquis and aspirin) for another 3 months (equaling 6 months total from time of Watchman implant?) After a clear TEE, shouldn't we be able to get off then?


Barb

Great question! Carey has addessed this before saying in Europe they do nothing but here protocol varies and that cardiology seems to have a need to do something!
Lots of variables like: another TEE at 6 months? Another at 1 yr? I cant wait to see answers. Im sure Watchman has a recommended protocol also

Does it have anything to do with one’s CHADS score waiting 6 months?

Here are two threads Tom referenced that Cary wrote about Eliquis protocol after the watchman :
[www.afibbers.org]



Edited 1 time(s). Last edit at 03/24/2022 11:36PM by susan.d.

The six month TEE is just a final check that the Watchman hasn't shifted out of position, developed a leak, and that there isn't a clot attached to it. By that time it should be completely enclosed in your own tissue and incapable of moving, leaking or developing clots, but all those things have occurred in the past so the TEE is a final check to ensure that hasn't happened. Unless you're in a clinical trial like I was, I don't see why a 12-month TEE would be needed.

Ahhh..no one has mentioned another TEE at 6 months to me. I will ask the cardiologist who is my follow up after the last TEE (Dr. DiBiase who is Dr. Natal'es protege) about that. Is this typically done for everyone after getting a Watchman implant?

As for CHAD score, Susan...nothing was mentioned about that at all. I don't think it has anything to do with this protocol, but someone may tell me otherwise here.....

I have my follow up phone call (I pushed to do it virtually since the hospital I had this done in is not close..) on March 30th. Will report back when I get some more answers.

Happy Friday all ~ Barb

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tobherd
As for CHAD score, Susan...nothing was mentioned about that at all. I don't think it has anything to do with this protocol, but someone may tell me otherwise here.....

Your CHADS score doesn't have much to do with the Watchman protocol, but the LAA isn't the only place that clots can form, so your CHADS score remains relevant. Closing the LAA eliminates 90% of the clots that form in the heart, but 1) that's not 100%, and 2) it doesn't do anything about clots forming elsewhere (DVTs, clots forming on arterial plaques, clots from surgeries and injuries, etc). That's why I remained on half-dose Eliquis despite having a Watchman. Like virtually everyone over the age of 60, I have "mild aortic plaque" and that was enough for 3 doctors to recommend remaining on it and enough for me to be convinced to do so. The alternative was daily low-dose aspirin, but Eliquis is safer and more effective than aspirin so that's a no-brainer choice.

Also, and after seeing hundreds of stroke victims in my time in EMS, my fear of strokes is about 10,000 times greater than my fear of anticoagulants. Remember: Death is by no means the worst outcome from a stroke.

I'm in a bit of a different category. I had a touch up ablation 2/15, only 13+ min of rf ablating, followed by a Watchman implant. My 45-day TEE is 3/29 to be followed by a six month TEE in Aug and a one year TEE in Feb 2023. My first TEE was in Oct 2017 six months after my second ablation. I'm certain Dr. Natale will explain everything after the procedure on 3/29. I will push for the 6 month and one year TEEs to be done locally since I'm going to St. David's for the 45-day one that is the most critical per The Maestro.

So if I'm following your thinking, Carey, wouldn't that mean that everyone who is over 60 should be on Eliquis? And if that's true, why isn't that recommended?

My Cardiologist said she doesn't have anyone who has had the Watchman, still taking any blood thinners. According to her, that was the whole reason for getting it. It doesn't seem that she believes it's necessary unless you at risk for some other reason(s) aside from age and the typical things that come with getting older....

Hard to know what's the best choice..

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tobherd
Hard to know what's the best choice..

Depends on how much you want to minimize risk. Afib & LAA ablation aren't the only stroke risks. Except for age & sex, is your CHADS2VASC score 0? If so, that is one answer, if not, then how high is it? That is another answer, in my book. Except for a brief period in 2004, i've never taken anticoagulation. However, I aspire to keep my blood pressure < 110/70 without meds. My A1c < 5%, fasting glucose in the low 80s (mg/dL), glucose after meals < 120 mg/dL (no meds). Body fat 15%. Lowest heart rate during sleep in the low 40's. Fitness, excellent without being excessive on the right side of the "U" shaped risk distribution for exercise. And so on. In different circumstances I might make a different choice.

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tobherd
So if I'm following your thinking, Carey, wouldn't that mean that everyone who is over 60 should be on Eliquis? And if that's true, why isn't that recommended?

My Cardiologist said she doesn't have anyone who has had the Watchman, still taking any blood thinners. According to her, that was the whole reason for getting it. It doesn't seem that she believes it's necessary unless you at risk for some other reason(s) aside from age and the typical things that come with getting older....

Because everyone over 60 doesn't have a CHADS score of 3 and doesn't have a history of afib. You can't just consider one factor. You have to consider the whole person and their medical history.

Your cardiologist explained exactly the reason why I'm still taking a half-dose of Eliquis. If I didn't take Eliquis, pretty much every doctor in the US would prescribe a low-dose daily aspirin for me because of my age (66), my CHADS score (3), my afib history, and my aortic plaque. But as I explained before, Eliquis is safer and more effective than aspirin, so I simply went with the superior choice.

Put a little differently, I don't take Eliquis because of my Watchman; I take it despite my Watchman. The Watchman simply allows me to make it a half-dose.

I’m surprised the 1/2 dose after a watchman or pre 45 day TEE is a uniform dosage regardless if someone with afib is a CHADS 2 or 3 or 5 or 6 (if you count gender).

I don't know what you mean by "uniform dosage."

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Carey
I don't know what you mean by "uniform dosage."

Watchman site mentioned 2.5 dosage (uniform dosage) plus a baby aspirin after the watchman until the 45 day TEE or 6 months. Plus I am aware everyone is different but from what I have read on this site, I don’t recall anyone after a watchman post they (tailored for them) are still on a full dose. In fact everyone who posted mentioned they are on a half dose.

Unless they have a leak I suppose…:

[www.jacc.org]
[www.tctmd.com]

[www.medscape.com]
“Half-Dose DOACs Cut Bleeding, Thrombus Risk Post-Watchman LAA Closure“



Edited 1 time(s). Last edit at 03/28/2022 03:50PM by susan.d.