Getting off of baby aspirin

I had my 6 month TEE after my Watchman implant about 10 days ago, and everything was perfect. No problems. I was told by Dr. DiBiase that I should continue the baby aspirin and could stop Eliquis, and the opposite by Dr. Natale. I knew that I didn't want to continue on aspirin, so was going in that direction, but had hoped to get off of the Eliquis too.

First I'm surprised that no one told me HOW to get off of the aspirin....some said I could just stop it cold turkey, and yet when you Google how to wean off of baby aspirin, all you can find are articles saying don't get off of it suddenly! -So I have been cutting it in half....shouldn't the protocol be clearer for this?

I don't have to stay on Eliquis either, and am still a bit unsure what I want to do. Shannon feels that it's a good thing to continue as we get older (I'm 69), as an added protection. I value his opinion and of course. Dr. Natale's, yet hear my own cardiologist saying that was the whole point of getting the Watchman - to get off of the blood thinners.

Would love to hear some thoughts on this from all of you ~ Barb

Just had my CA on Wednesday, and when he came around, my EP said I'd be on thinners (didn't say a name or type) the rest of my life. I suspect it is because the disorder is never cured, but always progresses. They don't want to lean over you as your eyes roll the last time and go..."Oops, didn't see that coming."

I've posted on this question many times, so I'll make it short:

The official FDA advice is to continue aspirin for life. I personally think that's bad advice. There's no solid evidence to support it, and there's a ton of solid evidence to support the notion that chronic aspirin use is an increasing risk as we age. It's the last thing the elderly should be taking if not absolutely necessary.

Eliquis is safer, especially at reduced dosage. And going along with Shannon's reasoning here, whether a Watchman needs it or not (probably doesn't), it's maybe not such a bad idea anyway. The LAA isn't the only source of stroke, and stroke is a vastly bigger risk to your life and quality of life than Eliquis is even if you have a Watchman.

Therefore, 4 years after my Watchman implant I continue half-dose Eliquis. My choice. I could have stopped everything and still could, but I don't plan to.

If I had a Watchman implanted now I would follow Carey's advice.

Taking Eliquis together with a Watchman is likely to reduce the risk of a stroke. I would continue with Eliquis until the CHAMPION-AF clinical trial is completed to find out if/when the Watchman is better or the same than a blood thinner for reducing the risk of a stroke. Don't know when that will happen.

Cardiac electrophysiologists with North Mississippi Medical Center are participating in a clinical trial that compares the WATCHMAN FLX™ device to blood thinner medication for preventing stroke in people who have atrial fibrillation (AFib).

NMMC in AFib Study: Blood Thinner vs. Device

Thanks, Carey - I did know what you chose to do, and can understand why, given your EMT background. I can stop all blood thinners too, but am feeling that staying on a low dose of Eliquis might be a good idea - not because of an Afib related stroke - I haven't had Afib in 8 years and now also have the Watchman - but because strokes can happen for other reasons. I'm still wavering a bit on that decision.

Still looking for guidance on stopping the aspirin. OK to stop cold turkey or not? If not, how best to wean off a 81 mg. of aspirin (it's a tiny pill)

Barb

Aspirin does NOT need weaning. If you want to stop it, just stop.

Ok, Carey, but when you Google it, there are nothing but posts about NOT stopping it suddenly. Here's just a couple:

[www.clevelandheartlab.com]

[www.capecodhealth.org]

Hence, my question and concern.

Those articles are about patients stopping aspirin against medical advice, not about some sort of need to taper down.

The way aspirin works is it disables your platelets. Once disabled, they stop working entirely until they die and are replaced, and that takes about seven days. So that means if you stop aspirin abruptly on a Sunday, the last of the disabled platelets will be replaced by next Sunday. If you think you're going to taper down by, say, taking another dose on Wednesday, all you'll do is disable all your platelets again and reset the clock to next Wednesday. Once you take your last aspirin, the platelets you disable will be replaced in seven days. It's that simple, so there really isn't a way to taper.

The advantage of a successfully sealed watchman implant is one can be on 1/2 dose Eliquis for life and are allowed to stop it for days (5 days for my situation) for surgeries, dental work, colonoscopy etc with no worries because one is still protected. The Eliquis is just extra stroke insurance.

I understand that, but the Watchman is primarily intended for use in people who've had their LAA isolated. Someone with a normal LAA who can tolerate anticoagulants and doesn't have some other major risk factors is unlikely to be approved for a Watchman. It's not considered a routine treatment for afib.

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Carey
It's not considered a routine treatment for afib.

Except on TV commercials for Watchman!

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Daisy
Except on TV commercials for Watchman!

Heh... yeah, so I've noticed.

I think it will likely become routine to place it during ablations, but I'm guessing that's 2-3 years off. Considering the dismal compliance rates with anticoagulants (<50%) and the huge costs of strokes, I think the insurance companies and Medicare will come to recognize the long-term cost reductions they'll achieve.

makes me wonder why they don't recommend Eliquis for everyone over the age of 60 or so....don't all older people need that insurance too?

There are no studies out there to support the idea of prescribing anticoagulants for people who don't have a known clotting risk, and the accepted stroke risk scoring measure, the CHADS-Vasc score, doesn't apply to people who haven't been diagnosed with afib. Anticoagulants do come with risks, after all, particularly in the elderly. So doctors are going to be very reluctant to walk out on that limb with no data and no accepted guidelines to support their decision. Until someone runs clinical trials, I doubt it will happen. And even when they do, those trials it will take years to complete.

Approved by who?

I have mentioned this is a previous post some time ago. My LAA was closed during a Mini Maze procedure many years ago, in addition to a "touch up ablation" a few years ago. I was told that I have the same risk of stroke as someone who does not have AFIB. My cardiologist would prefer I take a low dose aspirin for other reasons. I am still on the fence about taking low dose Eliquis for life. If I go into afib again, that is a no brainer. 73 at this point. At this stage of life risks/vs benefits, BTW I was diagnosed at 30 with AFIB, so I have had PLENTY of experimentation and opinions on me over the years by the best of them. I am grateful to still be here after weighing the pros and cons of every recommendation. Not to sound dramatic, we are not programmed to live forever no matter what or how many precautions taken. Hopefully you make the best decision you can with the information provided. Quality/vs Quantity of life - hopefully we get the best of both.

I faced the exact same question you face due to a Watchman, and I went with low-dose Eliquis. It's more effective than aspirin and it has a lower bleed risk. It's the better choice, IMO, if you're only looking for general cardiovascular protection.