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Tresjur
@tresjur

Posts: 42
Joined: Sep 19, 2016

Watchman Implant for A-Fib

Posted by @tresjur, Oct 5, 2017

I’ve been living with A-Fib for close to 20 years now. I took warfarin for 14 of those years and then switched to Pradaxa. After being on Pradaxa for 8 months, I started having GI bleeds and over the course of 14 months I had 8 blood transfusions. After ending up with a hemogloblin count of 5 and
an INR of 9, I ended up in ICU. After my release, and lengthy discussions with my cardiologist, we decided that my body could no longer tolerate the
blood thinners. For three years I went without any A-fib treatment and a year ago I started taking a full dose aspirin daily.

Early this summer I saw the TV ads for the Watchman, for people who cannot take blood thinners. It’s an jellyfish looking implant that is inserted in the
left atrial appendage of the heart. After implantation, heart tissue will grow over the device and provide blockage of clots that could travel to the brain.
I had the implantation done on September 13th, which requires an overnight stay in the hospital, and will be on Eliquis and an aspirin for about 45 days, then I will just take an aspirin daily for the rest of my life.

From reading the pros and cons of this device, it is my understanding that it does not work any better than blood thinners, but is an option for those who
cannot take the thinners. My first visit with the electrophysiologist is 2 weeks from today and at the end of October, I will undergo another TEE to determine
if all is working well.

I lived the 3 plus years not being on blood thinners with the though of stroke in the back of my mind. Even though I realize that nothing is 100% guaranteed or successful, I do have some relief now that I am again under treatment.

I’m posting this experience and wondering if anyone else has undergone this procedure and may be further along in their journey. It has been only 22 days
since my implant. I’m doing well so far and have not had a problem with the Eliquis so far.

Regards,
Mary

REPLY

Welcome to the Heart & Blood Health group, @tresjur,

Thank you so much for sharing your story; I’m certain that many Connect members will appreciate your insights.

I encourage you to view this discussion, “AFib questions” https://connect.mayoclinic.org/discussion/good-morning-im-almost-66-years-old-with-infrequent-afib-and-on/ where you’ll meet @frank4848 @cynaburst @predictable @patinhou @martishka @carnes @twptrustrek and others who have written about Afib, and alternatives to blood thinners.

I’d also like to introduce you to @liberty @tazio and @yoanne who’ve posted questions about the risks associated with blood thinners, and I hope they will join this discussion with their thoughts.

Here’s a clinical update from Mayo Clinic, which compares other procedures and devices like the Watchman: http://www.mayoclinic.org/medical-professionals/clinical-updates/cardiovascular/stroke-reduction-utilizing-left-atrial-appendage-exclusion

You may also wish to learn more about this open clinical trial/study at Mayo Clinic
– Assessment of the WATCHMAN™ Device in Patients Unsuitable for Oral Anticoagulation http://www.mayo.edu/research/clinical-trials/cls-20313922?_ga=2.226878683.790434124.1505482537-2033052444.1499398509

In the meantime, we look forward to getting to know you, @tresjur. Are their certain foods you have to avoid now? Do you have suggestions or tips for Connect members who may be considering this procedure?

Hi Mary!
Was very interested in reading your post. I’ve been on Eliquis for several years now and have had no problems until last month. On Sep 23, I developed a severe GI bleed, resulting in the loss of a lit of blood, a 5 day stay in the hospital, 2 blood transfusions and a significant setback overall. I believe my bleeding was caused from a gastric ulcer that started bleeding. Once the bleeding started, it wouldn’t stop because of the Eliquis. They gave me an anticoagulant to stop the bleeding and it worked. So, I’ve been off of all blood thinners since then, waiting for the ulcer to heal enough for me to restart the blood thinners. I’ve been in and out of aFib a number of times since then, and like you, worry constantly about having a stroke. I go back to my Electrophysiologist on Monday to see where to go next. I’ve been researching the pros and cons of the watchman and have about decided it’s my best bet. I’ve read where it isn’t as effective as a blood thinner, but then on the other hand, it’s not as dangerous either. I guess there’s no one stop quick fix, we just have to go with the best option. What do you think of my thoughts? Thank you so much for sharing your experiences.

Billie

@bergordon

Hi Mary!
Was very interested in reading your post. I’ve been on Eliquis for several years now and have had no problems until last month. On Sep 23, I developed a severe GI bleed, resulting in the loss of a lit of blood, a 5 day stay in the hospital, 2 blood transfusions and a significant setback overall. I believe my bleeding was caused from a gastric ulcer that started bleeding. Once the bleeding started, it wouldn’t stop because of the Eliquis. They gave me an anticoagulant to stop the bleeding and it worked. So, I’ve been off of all blood thinners since then, waiting for the ulcer to heal enough for me to restart the blood thinners. I’ve been in and out of aFib a number of times since then, and like you, worry constantly about having a stroke. I go back to my Electrophysiologist on Monday to see where to go next. I’ve been researching the pros and cons of the watchman and have about decided it’s my best bet. I’ve read where it isn’t as effective as a blood thinner, but then on the other hand, it’s not as dangerous either. I guess there’s no one stop quick fix, we just have to go with the best option. What do you think of my thoughts? Thank you so much for sharing your experiences.

Billie

Jump to this post

Hi Billie,

Because it has been less than a month since the Watchman was implanted, I don’t have much to offer in the way of pros or cons on its effectivity. For three years I was on nothing and then on 325 mg aspirin in the last year. What do you do when it seems your only option is to either bleed out or stroke out? Extremely scary worrying about either.

My decision to go with the Watchman was primarily to prevent clots and secondly to give me a little peace of mind from worrying about a stroke. Strokes (not A-Fib related) run in my family. I know what the quality of life is like after suffering a debilitating stroke from watching my aunt and grandma go through it. My primary care physician is happy with my decision as she had been worried about me not being on a thinner.

Your doctor will order a TEE to determine if you are an eligible candidate. The doctor will be looking for clots (hopefully none) and the size of the implant site to determine if the device will fit. Once I passed the TEE, because of my history of GI bleeds, I then saw my GI doctor who scheduled a colonoscopy and upper GI endoscopy looking for any areas that might bleed as I would again be on blood thinners. Two weeks before the procedure I went on coumadin, which was managed by an anticoagulation team that was in contact with me daily. My INR goal was 2.0 to 3.0 and but I never hit that mark. From day one, my INR was all over the place, but luckily after pigging out on leafy green vegetables the day before the implant, my INR went down to 3.0, and just prior to implantation it was a 1.9.

I stayed in the hospital overnight with hourly checks on the groin (incision site) and the stitches were removed the same day as the procedure. The incision site was rather painful that first day, but on the second day, the pain was down to a level 4. All looked good so I went home around noon.

I wanted to share my journey with you, however your journey may be different based on your current condition. I do know for sure that the initial TEE, and going on a blood thinner before and after the implantation is a requirement.

My suggestion to you is to do your due diligence, research, ask questions, and weigh the pro and cons. I even watched the procedure on YouTube…it’s amazing what is on YouTube, lol. What had me on the fence is finding out the Watchman can only be removed with open heart surgery. I pray that it never comes to that. Because I felt that I had really pushed my luck for four years without any treatment for the A-Fib, I decided I had to do something and for me the pros won.

My thought are if my body would/could tolerate the thinners I would stay on them, even with the dangers involved. I’m an advocate for “if it ain’t broke, don’t fix it.” I was doing fine on coumadin for 14 years then I switched to Pradaxa simply to avoid having to go for PT/INR testing. That’s when I ran into low hemogloblin and GI bleed problems. So far I haven’t had any problems with the Eliquis and should be off of them in another 25 days.

Regards,
Mary

Hello Mary, @tresjur

The detailed account of your history with A-Fib was great! I’m glad that you shared it with us. You gave us all a lot of insight into your thinking about this procedure. It should be very helpful to others who are considering a Watchman Device. I especially appreciate the way you recorded some of your thinking about the pros and cons. You displayed a real proactive response to your situation! Thanks,

Teresa

@hopeful33250

Hello Mary, @tresjur

The detailed account of your history with A-Fib was great! I’m glad that you shared it with us. You gave us all a lot of insight into your thinking about this procedure. It should be very helpful to others who are considering a Watchman Device. I especially appreciate the way you recorded some of your thinking about the pros and cons. You displayed a real proactive response to your situation! Thanks,

Teresa

Jump to this post

@tresjur
hello Mary and Teresa. as I mentioned some time ago, I had a surgical ablation together with a mitral valve repair. until now I’m doing very well, no A-Fib .anymore as far as I can feel. I’m still on Eliquis at a lower dose, to prevent bleedings like I had on Xarelto. the dose reduction was possible, because of my low weight (50 kg).
a couple of weeks ago I went to the heart center of cologne/germany. ,where I got the newest results of their investigations.in particular I was interested to read about the actual recommendations as to the surgical options for the treatment of A-Fib. They referred to the american society of thoracic surgeons 2017 :
The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation (
http://www.annalsthoracicsurgery.org/article/S0003-4975(16)31615-0/abstract

I understood that no further anticoagulation is necessary wenn an echocardiogram before discontinuing anticoagulation shows adequate LA emptying by the absence of spontaneous LA echocardiography contrast .on the other hand they recommend the implantation of a watchman device (never heard of that name before!! ) if possible!!. I intend to discuss these new findings/recommendations with my cardiologist next month. also I like to have a copy of the operation protocol, maybe they implanted such a device (if not why didn’t they do it, ? maybe repair of the mitral valve + ablation + watchman would be too risky for me?
I hope these informations are helpful for you.
yoanne

Hello @yoanne

It is good to hear from you. I am glad to hear that you benefited from Mary’s (@tresjur) sharing of her personal experience.

Unfortunately, we are not medical professionals and therefore cannot advise you about your particular medical situation (your own doctor would need to address these issues). Also, regarding the operation protocol, you would probably need to discuss this with your doctor. as well.

However, here is some general information about the Watchman Device from Mayo Clinic’s website, http://www.mayoclinic.org/medical-professionals/clinical-updates/cardiovascular/stroke-reduction-utilizing-left-atrial-appendage-exclusion.

As you are working through this decision process, please keep posting and let us know how you are doing. Also, if you have any particular comment or question about Mary’s (@tresjur) experience please let her know!

Teresa

@bergordon

Hi Mary!
Was very interested in reading your post. I’ve been on Eliquis for several years now and have had no problems until last month. On Sep 23, I developed a severe GI bleed, resulting in the loss of a lit of blood, a 5 day stay in the hospital, 2 blood transfusions and a significant setback overall. I believe my bleeding was caused from a gastric ulcer that started bleeding. Once the bleeding started, it wouldn’t stop because of the Eliquis. They gave me an anticoagulant to stop the bleeding and it worked. So, I’ve been off of all blood thinners since then, waiting for the ulcer to heal enough for me to restart the blood thinners. I’ve been in and out of aFib a number of times since then, and like you, worry constantly about having a stroke. I go back to my Electrophysiologist on Monday to see where to go next. I’ve been researching the pros and cons of the watchman and have about decided it’s my best bet. I’ve read where it isn’t as effective as a blood thinner, but then on the other hand, it’s not as dangerous either. I guess there’s no one stop quick fix, we just have to go with the best option. What do you think of my thoughts? Thank you so much for sharing your experiences.

Billie

Jump to this post

When I hear about all the problems with Pradaza and Equis I am thankful that I am still on warfarin

@bergordon

Hi Mary!
Was very interested in reading your post. I’ve been on Eliquis for several years now and have had no problems until last month. On Sep 23, I developed a severe GI bleed, resulting in the loss of a lit of blood, a 5 day stay in the hospital, 2 blood transfusions and a significant setback overall. I believe my bleeding was caused from a gastric ulcer that started bleeding. Once the bleeding started, it wouldn’t stop because of the Eliquis. They gave me an anticoagulant to stop the bleeding and it worked. So, I’ve been off of all blood thinners since then, waiting for the ulcer to heal enough for me to restart the blood thinners. I’ve been in and out of aFib a number of times since then, and like you, worry constantly about having a stroke. I go back to my Electrophysiologist on Monday to see where to go next. I’ve been researching the pros and cons of the watchman and have about decided it’s my best bet. I’ve read where it isn’t as effective as a blood thinner, but then on the other hand, it’s not as dangerous either. I guess there’s no one stop quick fix, we just have to go with the best option. What do you think of my thoughts? Thank you so much for sharing your experiences.

Billie

Jump to this post

Donald,

How long have you been on warfarin? I was on it for 14 years with no problems – switching to Pradaxa was my downfall.

Mary

@hopeful33250

Hello Mary, @tresjur

The detailed account of your history with A-Fib was great! I’m glad that you shared it with us. You gave us all a lot of insight into your thinking about this procedure. It should be very helpful to others who are considering a Watchman Device. I especially appreciate the way you recorded some of your thinking about the pros and cons. You displayed a real proactive response to your situation! Thanks,

Teresa

Jump to this post

I have been on Xarelto for about 6 weeks. I have always bruised easily and had a slow blood clotting time when I was younger. I’m beginning to get lots of new bruises. Hoping I can stay on a thinner though because like all of us I’m worried about clots.

I’ve been on Warfarin for several years with no problem. I cringe when I read about Equis and Xeralto

@donaldwnelson

I’ve been on Warfarin for several years with no problem. I cringe when I read about Equis and Xeralto

Jump to this post

/Why does Xarelto make you cringe. I thought Warfarin had the same cons.

To me the only drawback with being on warfarin, is the monitoring INR levels, is what the other products advertise as being their advantage. A possible down-side to the newer products is that unlike warfarin, there isn’t an antidote to reverse their effect in an emergency. I’m not sure if this is actually true, but certainly something to ask your healthcare professional about. I’ve been on warfarin for 5 years now without problems, other than the occasional INR being a little too low or two high depending on diet and hydration.

@gr82balive

To me the only drawback with being on warfarin, is the monitoring INR levels, is what the other products advertise as being their advantage. A possible down-side to the newer products is that unlike warfarin, there isn’t an antidote to reverse their effect in an emergency. I’m not sure if this is actually true, but certainly something to ask your healthcare professional about. I’ve been on warfarin for 5 years now without problems, other than the occasional INR being a little too low or two high depending on diet and hydration.

Jump to this post

Thank you, I had thought that I was on Xarelto because it was newer and didn’t have to be monitored as closely. Didn’t know there was a down side. I will have a discussion with my cardiologist about why he put me on this vs. Warfarin. I’m new to all of this.

@gr82balive

To me the only drawback with being on warfarin, is the monitoring INR levels, is what the other products advertise as being their advantage. A possible down-side to the newer products is that unlike warfarin, there isn’t an antidote to reverse their effect in an emergency. I’m not sure if this is actually true, but certainly something to ask your healthcare professional about. I’ve been on warfarin for 5 years now without problems, other than the occasional INR being a little too low or two high depending on diet and hydration.

Jump to this post

Today I reached the one-month mark since I had the Watchman implanted. My first follow-up appointment with the electrophysiologist is on the 17th and I pray all is okay. I’m feeling well but look forward to getting off the Eliquis as it does scare me that there is no reversal in case of bleeding. The next step is another TEE (on Oct. 30) to look at the implant from the esophagus.

Will keep you updated as I progress.

Mary

@gr82balive

To me the only drawback with being on warfarin, is the monitoring INR levels, is what the other products advertise as being their advantage. A possible down-side to the newer products is that unlike warfarin, there isn’t an antidote to reverse their effect in an emergency. I’m not sure if this is actually true, but certainly something to ask your healthcare professional about. I’ve been on warfarin for 5 years now without problems, other than the occasional INR being a little too low or two high depending on diet and hydration.

Jump to this post

Hi Mary! Glad to see things are working with your Watchman so far!! I know you’re anxious for Oct 30 to come. You mentioned that there is no reversal to stop bleeding when you’re on Eliquis, and I’ve seen others mention it as well. But when I went to the ER last month with a life- threatening gastric bleed, they were able to give me something that reversed the Eliquis. And the bleeding stopped immediately. Of course by then I had already lost a lot of blood and had to have two blood transfusions that week. But whatever they gave me worked very well. I’ve been on Eliquis for a couple of years and had no problems with it. My bleeding was caused from an ulcer that broke open, and of course, as with any blood thinner, it was down hill from there!! I’m on my long path now to get approved for the Watchman. My Electrophysiologist has already said I was a candidate – I just have to get approval from my cardiologist and my gastric doctor. Ugh!!! I hate the waiting.

I’m keeping you in my thoughts and prayers that all will continue to go well for you.

Billie

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