watchman vs blood thinner

Watchman vs. anticoagulants and pacemakers

by AgentX86 - 2019-09-14 00:16:56

There is nothing about a pacemaker that should require anticoagulants or a Watchman.  No pacemaker I know of causes clotting (but there is always room to learn something).  However, if you also have AF, or similar arrhythmia, then they're essential (but a pacemaker isn't going to help that).  It would be good to have more information.

Most would jump at the chance to replace their anticoagulants with a Watchman but most insurance won't cover it, universally, (yet).  Often they require that the patient be a high risk for bleeding or have other problems that contraindicate anticoagulants.  This is changing because the better anticoagulants are expensive and the Watchman is permanent.

There isn't anything scary about the insertion of the Watchman.  They did much of the same sort of work when they implanted your pacemaker or for ablations.  If you want to be scared, they do that while you're awake!  ;-)

I had my LAA clipped during CABG surgery, so a Watchman wouldn't do anything if they could put it in but because I'm permanently in Aflutter, my EP has me on a NOAC (Eliquis).  I'm not sure why but he says that the stroke risk is still too high.

As I indicated above, I'm on Eliquis and have been for most of the last five years.  I was on warfarin when I was first diagnosed with Afib (2007) and then again when it came back (2014).  After my CABG, it was clear that I was going to be fighting Aflutter, forever, (Maze gone wrong) they switched me to Eliquis.  Eliquis is far superior but it's really expensive (full boat cost would be over $200/mo).  I have very good insurance, so it's cost is manageable.

No, doctors don't get kickbacks. 

Can't put in an implantable whilst on anti-coagulants

by crustyg - 2019-09-15 05:11:22

Hi:

No doc will fit you with a pacemaker and leads while you are anti-coagulated - the risk of serious bleeding where the leads go into the big veins is too high and it's not easy to just press on the vein for 10min while the bleeding stops the way that you would for a hole in a near-surface vein in your arm.  For patients already on an anti-coag (usually a xaban == NOAC) they would wait a while before restarting.

One of the biggest stroke risks for patients with Afib and Aflutter is pooling of blood in the left atrial appendage, which can, over time, form a clot, which can then break off and whiz up to your brain.  There is a standard stroke risk scoring system CHADSVASC, now updated to CHAD2-DS2-VASC which predicts your risk of a stroke with Afib/Aflutter using factors like Age, Diabetes etc. (you can look it up), and depending on where you live in the world pretty much dictates when your doc will recommend an anti-coag.  Once you reach a score of 2 the evidence of the risk/benefit ratio of anti-coagulation seems to be well validated (esp with a NOAC).

Given that most strokes are caused by formation of a clot in the brain blood vessel (40%), or a bleed from a brain blood vessel (40%) and clots arriving in the brain only accounted for 20% of strokes (back in the day), having a clot form in the heart and then travel to your brain is uncommon in the general population - but's it very different for folks in Afib/Aflutter, so this risk really matters.

watchman vs blood thinner

by new to pace.... - 2019-09-15 14:50:04

thanks for your comments.  i looked at theCHAD....... and discovered that since am 79 and female  am on the list for the blood thinners. The down size with Watchman is it only covers the heart clots.  Where as taking something cover all locations.  Which i guess will have to take.  The only question is which one?

Any of the novel anti-coagulants - the 'xabans'

by crustyg - 2019-09-17 11:20:23

I don't have shares: I am *told* that the evidence base for apixaban is the largest/best for the low risk of a serious bleed versus the stroke reduction benefit of being anti-coagulated.  The tablets are tiny and can usually be swallowed dry (but water/liquid always better if available), the 2*7 blister packs make it easy to manage the stock and remember what's been taken and 08:00 and 20:00 is a really convenient twice-per-day regimen.

What's not to like!  Unless you have to pay for it yourself - not so funny.

Except that I hate being anti-coag'd and came off them as soon as I could - falling from a road-bike at speed onto tarmac at 25mph+ isn't funny if you don't clot well.  And yes, it's happened to me, but not while on apixaban.

watchman

by Tracey_E - 2019-09-18 10:21:05

I don't know a whole lot about it but I know two medical professionals (also heart patients) who were offered it and both refused it, primarily due the risks associated with inserting it. Do your homework, find out how many your surgeon has done and how many of those ended up with complications. 

Perhaps some confusion

by AgentX86 - 2019-09-19 13:00:29

A Watchman is used to close the Left Atrial Appendage for those with Atrial fibrillation or flutter. It obviously does nothing for clots formed elsewhere. However, for those with Afib or Aflutter, more than 90% of the colts are formed in the LAA due to the interrupted blood flow. Either an anticoagulant or closing the LAA will eliminate this source of stroke, bringing the patient's odds of a stroke back in line with the normal population. A Watchman has some small risk (competence of the EP is assumed) but the risk of a lifetime of anticoagulants isn't anywhere close to zero, either. NOACS reduce the risk of bleeding into the brain but it's nonzero.

Originally, the Watchman was only for those who couldn't take anticoagulants but experience has shown that not only are they safe and effective but also cost effective. They are becoming more widespread because they are a good solution.  I would gladly have one implanted if I could ditch the Eliquis (but I already have my LAA clipped and still need to take it).

watchman versus blood thinner

by pogerm1 - 2019-11-20 14:52:45

The LAA can be closed off when doing an ablation, but you might still need a blood thinner.  A watchman is implanted after the lAA is closed off.  There have been testing of the new Watchman this past year and it is supposed to be a lot better, perhaps in another year it will be on the market.