Are LAA ablations still being "fine tuned"?

I had a LAA ablation back in 2013 with Dr. Natale, and did attend one symposium a number of years ago I keep getting emails about upcoming LAA symposiums and it always looks like there must be new information coming out, which makes me wonder.....is this procedure still being "fine tuned"? I am still taking a low dose of Eliquis, and I think it's because they really aren't 100% sure it's OK NOT to take it when after having a LAA ablation. I also have the Watchman implant, so I would think that would be enough, but when I see these emails, I do think.....they aren't completely sure they have this "down".

Any thoughts on this?

Barb

You're misinterpreting those emails. That symposium runs every year, like many science symposiums do. Science and medicine don't stand still, and almost all procedures undergo gradual changes and improvements. That's normal and desirable. Since you have a Watchman and you're on 1/2-dose Eliquis, you really don't have anything to worry about.

Quote
tobherd
I am still taking a low dose of Eliquis, and I think it's because they really aren't 100% sure it's OK NOT to take it when after having a LAA ablation. I also have the Watchman implant, so I would think that would be enough, but when I see these emails, I do think.....they aren't completely sure they have this "down".

Barb, the reason it has been suggested for you to take a low dose of Eliquis isn't because the Watchman doesn't protect you from a clot in the LAA, it does. It is because even after a successful ablation (meaning no more afib), there is an association between having had afib (even though you aren't having it now) and a higher stroke risk. See the paper I posted here. They aren't certain of the root cause of this association.

If someone had a successful N watchman implant but is in afib, will the afib stroke risk still apply if they temporarily stop 1/2 dose eliquis for a procedure? My colonoscopy was canceled, scheduled for tomorrow, because my current EP believes I may have a stroke risk if off Eliquis a couple of days pre-procedure. I thought that was the benefit of getting a watchman. Or maybe if one is in nsr and have a watchman, then stopping eliquis for two days the risks dont apply. I had no risk warning last year for my colonoscopy and my watchman was only a week old.

Dr. Natale had told me that I could get off of Eliquis for a few days, or even a week or more if I needed to for some reason. I was considering taking a strong anti-inflammatory med that had caused a weird bruise above my eye, when I was on Eliquis, so he OK'd getting off of it if I wanted to take that med again. I do have the Watchman and no afib for 9 years.

Thanks, Carey.

So I don't understand this. Why are people who just get a regular ablation, many w/o even getting a Watchman, told that they can get off of blood thinners? It seems that the LAA ablation might be the reason those of us who've had this, are told to stay ON blood thinners. My cardiologist even said, "that's the whole point of getting the Watchman...to get off Eliquis, etc. She says her other patients who got ablations (not sure if they all had Watchmans too), no longer take them.

Why the difference? Some people with ablations are told it's fine to stop taking them, and some of us are told...it's better to stay on them.

BArb

Barb, that Watchman makes all the difference. A Watchman reduces your stroke risk to the same level as someone who doesn't have afib no matter whether you've had an ablation or not and what type it was if you did. The people being told to remain on anticoagulants don't have a Watchman device. That's the difference. You have one, so you can relax about all this. It really just doesn't matter for you.

Quote
Carey
Barb, that Watchman makes all the difference. A Watchman reduces your stroke risk to the same level as someone who doesn't have afib no matter whether you've had an ablation or not and what type it was if you did. The people being told to remain on anticoagulants don't have a Watchman device. That's the difference. You have one, so you can relax about all this. It really just doesn't matter for you.

Thats what I was told to believe. My Watchman report, written by Dr Natale, stated I should be permanently on a NOAC. Is the stroke risk the same after a watchman if one is in nsr or afib? Is the stroke risk the same if someone has a chads score of 1 vs 5?

Dr Natale gave me advice the same day of my ablation, after he was reassured my watchman was sealed, that I could be off eliquis for 5 days to get an emergency colonoscopy— but I was in nsr. Now in afib a different EP says I have a stroke risk even with a TEE showing a perfectly sealed watchman.

It doesn’t make sense unless my chads score of 5 is the reason but you stated “a watchman reduces your stroke risk to the same level as someone who doesn't have afib“. Every time in the past if I went to the ER, the first question was if I am on a NOAC. Once I mentioned I have a sealed watchman, their concern ceased. Not one ER doctor was concerned.

I doubt if someone with a chads 5 who never had afib needing surgery or a colonoscopy or any procedure are told they are taking a stroke risk by getting any procedure done.



Edited 1 time(s). Last edit at 10/31/2023 10:13AM by susan.d.

Quote
tobherd
It seems that the LAA ablation might be the reason those of us who've had this, are told to stay ON blood thinners. My cardiologist even said, "that's the whole point of getting the Watchman...to get off Eliquis, etc. She says her other patients who got ablations (not sure if they all had Watchmans too), no longer take them.

Yes, ablating the LAA usually increases your stroke risk as it reduces the circulation in the LAA—hence the recommendation for a Watchman afterwards. But, many EPs still recommend taking some form of anticoagulant post Watchman to deal with the 10% risk of a clot NOT coming from the LAA. I am taking 2.5 mg of Eliquis which doesn’t bother me at all and is now available as a generic from Canada.

What Daisy said. I also continue a half-dose of Eliquis for those reasons.

And your CHADS-Vasc score always matters. Those 10% of clots that come from non-LAA sources are more likely to happen if you have a high score.

So do we have the same 10% risk as anyone else might in terms of a clot coming from a non LAA source? Because if we do, then shouldn't everyone be on a low dose blood thinner?

Barb



Edited 1 time(s). Last edit at 10/31/2023 11:31PM by tobherd.

Quote
tobherd
So do we have the same 10% risk as anyone else might in terms of a clot coming from a non LAA source? Because if we do, then shouldn't everyone be on a low dose blood thinner?

Yes we do, and that's an excellent question. You're not the first to ask it. The problem is, only people with afib have been studied. Would anticoagulants benefit everyone with a high CHADS-Vasc score? The answer is probably yes, but I don't think society is ready to confront that question just yet.

Is that the reason my EP warns of a stroke risk if I stop eliquis for two days to get my colonoscopy because my chads score is 5? If that’s the case then most non afib elderly shouldn’t get procedures because of the 10% risk.

susand my mother had a stroke when they took her off Coumadin for 5 days for a colonoscopy. But she was fine with another surgery when they "bridged her"_ I forget if it was heparin or luvinox. In any case they swtiched her to ashort-acting anti-coagulant, did the surgery, put her on the short term one then switched back to Coumadin.

Windyshores- I speculate your mother didn’t have a watchman implant. I am just curious if someone has had the watchman implant, stroke odds should be the same as a non afib person, why then am I am warned I could get a stroke if I stop 1/2 dose eliquis for two days pre colonoscopy?

If I never had afib I speculate I would never be warned about a stroke risk associated with a colonoscopy. I still haven’t had my colonoscopy. I’m waiting to fly home where I have my EP and GI at the same hospital.