TEE after Watchman Implant - When can I stop Eliquis?

Dr. Natale put my Watchman in on 4/27 this year. They couldn’t get my first TEE scheduled until today (7/26) - a full 3 months after my Watchman. The first TEE is typically done 6-8 weeks after the implant is put in.

I was under the impression that for most people the Watchman is fully sealed over within 4-6 weeks. Given my first TEE was done a full 12 weeks after my Watchman I thought there would be a good chance I’d get the green light to stop taking my Eliquis.

Dr. Natale told me after the TEE that everything looked great but he wanted me to stay on my half dose of Eliquis and come back in 4 months to determine if I could stop the Eliquis at that point.

I’m just curious for those of you that have had Watchmans put in by Natale at what point were you given the green light to come off the Eliquis? Is it typical to be given the green light to come off of it after the first TEE or is it usually the second TEE? I’m just bummed I have to wait another 4 months.

Travis

No, it's not typical. I was given the green light at six months, but his advice was to continue half-dose Eliquis for life. Not because of the Watchman, but because I'm a typical westerner of my age with mild aortic plaque and hypertension. My PCP and my local EP agreed with his advice. The LAA isn't the only source of embolisms.

Quote
tvanslooten
I’m just curious for those of you that have had Watchmans put in by Natale at what point were you given the green light to come off the Eliquis? Is it typical to be given the green light to come off of it after the first TEE or is it usually the second TEE? I’m just bummed I have to wait another 4 months.

When I was in Austen recently for my first TEE to check on my Watchman (Dr. Natale put mine in the day before yours) Shannon came in before Dr. Natale and demonstrated the stages of how the body integrated the Watchman. At our stage it is not complete and, as I remember, she said that it would take about a year. Though mine also looks perfectly placed, Dr. Natale said that in another 4 months we could discuss either taking a baby aspirin every other day or continuing with a half dose of Eliquis. He did not mention the possibility of stopping anticoagulation all together—though that decision probably depends on individual variants. He said that as of now, it is safe to stop Eliquis for up to a week if necessary for a medical procedure. I will have my next check locally and Shannon said that we would have a video appointment to discuss those results.



Edited 1 time(s). Last edit at 07/27/2023 12:26AM by Daisy.

Daisy:

So you and I are on the same exact track. Glad to hear you’re doing well and that your first TEE was good! You are doing your second TEE locally? I’m thinking about doing that as well because in four months we’ll be into November and we’re going to be super busy with the holidays so another trip to Austin isn’t going to be so easy that time of year.

Can I ask you what’s involved to do it locally? Does Natale have recommendations for local cardiologists to do them or do we just have to find someone on our own? I know Natale is super particular about who does the TEE’s and how they do them.

Travis

Quote
tvanslooten
Daisy:

So you and I are on the same exact track. Glad to hear you’re doing well and that your first TEE was good! You are doing your second TEE locally? I’m thinking about doing that as well because in four months we’ll be into November and we’re going to be super busy with the holidays so another trip to Austin isn’t going to be so easy that time of year.

Can I ask you what’s involved to do it locally? Does Natale have recommendations for local cardiologists to do them or do we just have to find someone on our own? I know Natale is super particular about who does the TEE’s and how they do them.

Travis

Because of the difficulty in getting a TEE done properly outside of Austin, Dr. Natale and Shannon have suggested that I get a chest CTA which will show them what they need to see and it is hard to screw up. I am hoping that my local cardiologist will be willing to act on the order that Dr. Natale will send. If Dr. Natale happens to be familiar with a cardiologist in your area he would probably recommend seeing them I think, though for most of us we will have to work with our own local cardiologists—I know that he does not have a relationship with any cardiologists in my city.

I had my first TEE in Austin a few weeks weeks ago (same day as Daisy), and was told the same thing - to continue with half dose Eliquis until the next TEE in four months. My Watchman is showing to be in place without leaks, but I wouldn't want to get off Eliquis at this point. For me it's peace of mind having that extra layer of protection. In fact, I'll probably want to continue taking it beyond the six month point, even if aspirin is an option then.

~ Linda

Quote
LLA
In fact, I'll probably want to continue taking it beyond the six month point, even if aspirin is an option then.

That's exactly what I did and aspirin was an option. So was taking nothing.

Isn’t one’s CHADS number a factor in deciding if one should safely stop Eliquis? Would hereditary stroke history of family members also a factor?

I personally have no problem with taking 2.5mg for life. It’s a layered security.