Watchman

Does anyone know anything about "watchman", a device to prevent blood clots causing strokes ?

Or has anyone on here actually had the operation ?

There has just been a feature on my local tv station stating that this device is now available in our area (Cumbria and Northumbria) for people with AF.

Evidently it is an "umbrella" type filter installed in the heart which prevents blood clots entering the bloodstream and they claim that after the operation there is no longer any need for anticoagulants or warfarin which in time can cause internal bleeding

The heart grows around it and there is no need for future replacements so you would be off anticoagulants and such for life

I have found that St Mary's hospital in London were doing this operation in London in 2009

If it is good you would think that we all would be treated this way saving the NHS millions

Try this link, if it does not work there is a lot of info on Google

hahttp://www.dailymail.co.uk/health/article-1245520/A-Wat..

Keep well everyone

32 Replies

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  • If you look up the Surrey Group meeting there was a talk about this device recently. It is only available for a very small minority of patients for whom anticoagulation is not suitable for other health reasons.

    Bob

  • Thank you BobD.

    I suspected that and I see the cost of the operation is high. But the TV programme said something on the lines that it is available to all people in our area with irregular heart beats and that they would like to hear from people who are interested in the operation.

    It might put peoples hopes up but we all need some light at the end of the tunnel and is worth looking into even if it is not to be

    Also even if it is only for a small minority of people who have problems with anticoagulation it must be good news for them

    The TV report probably got it wrong because they also said that warfarin was the only other alternative which as we all know is not true

    But to me prevention is always better than the cause because the older you get the more likely you are to have problems from blood thinners regarding internal bleeding, But will the powers that be see it that way?

  • Hi yes

    This is the alternative to the left atrial appendage occlusion, (LAAO) however bearing in mind I am not medically trained, not sure you are "off warfarin for life" unless I have misunderstood something, it certainly reduces the risk of clots considerably, but 100% ?

    As for saving millions (sorry but I am a beancounter) Warfarin costs the NHS around £1.18 a day or £430 per year (including blood tests), so if the average person lives for say 20 years on warfarin, then the op would need to be costing less that £8,600 to save any money at all.

    Note I have not worked this out with NPVs (for those who know what they are) not taken into account what could be argued as the additional costs of any strokes. For that we would need to need to know how many strokes a year would be saved by the procedure, and it would certainly be a reasonably high number, and then yes it could save £millions

    Be well

    Ian

  • The specialist interviewed on the TV programme did say that AF sufferers should not have to take blood thinners any more after the operation and his patient who was also interviewed ( a retired major) said that he now did not have to take warfarin or other blood thinners and therefore he did not need to worry any more about being admitted to A and E for blood transfusions as he had done numerous times in the past

    Are they telling the truth or just mistaken ?

    If this is the truth it would be a Godsend for people who are intolerable to blood thinners as we will all eventually be as we grow older

    The article I posted also seemed to allude to the same thing but with me also not being a medical expert and optimistic I might of picked it up wrong

    That article is now 5 years old so I thought that there might be people on here who might have had the device fitted since then and we may have got feedback and the true picture from them

    That is why I posted it

    As for cost effectiveness, including the net present value does anyone have any actual figures for the TOTAL costs of being treated on warfarin including INR monitoring, use of doctors time, nurses time, travel expenses and personal time off work to attend ?

    According to this article strokes alone directly cost £2.8 billion pounds

    dailymail.co.uk/health/arti...

    Keep going everyone and the best of luck

    Things seem to be looking up regarding treatment

  • HI gringo

    Yes the total cost of warfarin is what I quoted, and that includes blood tests doctors time, nurses time, fixed costs etc, but of course not any personal costs such as travelling. £1.18 a day. It's one of the cheapest drugs that doctors prescribe, literally pennies per month for the actual drug cost.

    But I agree it's the strokes saved costs that would be the big number in savings

    Be well

    Ian

  • Thanks for that Ian

    I have never been on warfarin myself so was not fully aware of what monitoring involved

    Below is an interesting article that I came across of what monitoring entails and it shows what value for money it is considering the amount of people involved at the cost of £1.18 per patient

    I thought that the article might be enlightening for people who do not know the full procedure

    The great thing about this forum is the knowledge that is passed on to us by people's expertise and the experience of what they have been through

    dayhttp://www.nps.org.au/medicines/heart-blood-and-blood-vessels/anti-clotting-medicines/for-individuals/anticoagulant-medicines/for-individuals/active-ingredients/warfarin/for-individuals/living-with-warfarin/tests-and-monitoring

    I do note in this article that people who are not fortunate enough to be able to attend clinics through travel, locality or health reasons can take advantage of a portable monitoring device exercised by point of care experts or they can self monitor at home (after training ) but they have to cover the cost themselves

    I suppose because of cutting out a lot bookings and attendance, etc that it would be reasonably cheap going on the above expense rate ?

    My father in law who is an amazing 91 years old is on warfarin and is unfortunately starting to struggle getting to his venue. He is considering self monitoring with the help of his wife ( she is only 80 )

    Do you or anyone else have any idea of what the self monitoring will cost him ?

    Any help or advice would be really appreciated folks

    Thank you again, keep well and sorry for a lengthy post

  • Hi greengo

    Interesting article, I have to say the reality is somewhat different, "every one or two days to start" is seldom more frequent than weekly initially, at least in the UK.

    And then "once a month" often translates to once every 12 weeks for those with a stable INR, only monthly if like me, you go up and down like a yo yo

    I have to say if you went to my blood test clinic they go through around 150-200 people in 2 and 1/2 hours very fast and the lab is on site so the results are usually with you that afternoon if any changes needed. And they do this four days a week.

    Re Self Testing I can only talk for the UK. You can buy a Roche self tester for £299.00 (No Vat if on warfarin) and you are SUPPOSED to be able to get the test strips on prescription, but many doctors refuse this. Again depends on your clinic, but mine require the results phoned through and then they tell you what dosage to take, some people are allowed to self amend dosage (but most do even if they shouldn't)

    Test Strips cost £68.16 for 24 and £133.26 for 48 (should be able to not pay VAT on those)

    shop.coaguchek.com/

    There was a fascinating talk about INR at the 2013 AFA patients day, the expert who spoke said how unreliable the test was, and how it made a difference with things like finger prick/venal blood, time before testing, and even WHO was doing the testing. He said the results were no better than +/- 0.5 in accuracy and said if he was on warfarin he'd go for 2.5 to 3.5 not 2 to 3.

    Be well

    Ian

  • Thank you Ian

    I was particularly interested in the self monitoring or mobile on behalf of my father in law, I will pass that info on to him

    Thank you again for your time in replying

    John

  • I am actively pursuing this line of defence and have an appointment to discuss it with my EP next week. Ten centres in the UK have been nominated for an evaluation study and I hope, if he thinks it a good way forward, that he might consider referring me.

  • Best of luck Rellim, please let us all know how you got on

  • My EP thought that there would be strict criteria for any evaluation study and has not moved me in that direction. If I wanted to take it further, I would not be NHS funded.

  • Thank you for your update Ian.

    Sorry to hear that

    Are you actually located in one of the ten centres chosen for evaluation that you mentioned ?

    John

  • No. I'm in Cumbria, miles from any centre. My ablations have been in Manchester and Blackpool. I'm about 75 miles from Leeds or Liverpool, which are two of the centres chosen.

  • Hi Rellim

    I'm in Cumbria as well (Carlisle )

    The strange thing is that a couple of weeks ago Border News and Look Around did a feature about Watchman and actually had a guy on from Brampton who had it fitted.

    This is how I first heard of Watchman

    I missed the start of the feature but they said that it was now available in "our area " which I assume is The Border Television area

    There might be other conditions about having it fitted but it seems that living in Cumbria alone does not exclude anyone because as you know Brampton is in Cumbria

    They also said that they would like to hear from anyone who might be interested in having it fitted

    As I said, I did not see the full report but I think that it may have been fitted at Freeman hospital in Newcastle

    I do not see my EP until March but i will try to look into this a bit further before then

    Maybe I can find the programme on the web, albeit with my limited skills

  • That's interesting. Thanks. Carlisle is in a different hospital deanery - it's in with Teesside, Middlesbrough, North Allerton and Newcastle. I'm down near Kendal. We get Border News though, so I'll have a look too.

  • The annoying thing with Border television is that they pretend that Lookaround is being aired from Carlisle when it is now coming from a Newcastle studio. The people who present it are merely sitting with a backdrop of The Citadel at Carlisle. The view is from a security camera. On top of Border TV covering a vast area these people often forget that they are actually in Newcastle so "our region" could be anywhere.

    BOL

  • What a con! It is an odd area that Border covers. We have an aerial that picks up Granada but that's not very relevant most of the time either.

  • I've found that and watched it. It was on November 10th.

  • Have you got a link for that Rellim ?

  • itv.com/news/border/topic/l...

    I googled Lookaround Border TV I think. When I repeated the steps I got the above. Then search for 'umbrella' in the search panel. It was broadcast on November 10th.

  • Thank you for that, here is another link

    According to this it seems that the 10 centres where it is now available are being used to assess results and costs so as to evaluate whether it will become generally available or not to all on the NHS. Let us hope that it fills all the requirements

    thttp://www.cumbria24.com/news/2014/11/09/cumbria-patient-hails-new-heart-procedures-stroke-prevention

    Thanks again

  • Thanks for that. Sounds good to me! I am a bit disappointed that my EP did not wish to refer me. I would love to be able to give up anticoagulation. I don't like the feeling that I have departed from normality by taking warfarin, rendering me at more risk from accidental bleeding. It makes me unwilling to do anything that might cause injury. I also have an irrational fear that I'm one of the few people who may have some sort of haemorrhage. Every night at six I feel I will ultimately regret what I'm doing. Or perhaps I will be so dead that I won't notice.

  • Hi there

    What you are saying is the reason why I refused warfarin and went on rivaroxiban instead. It has the advantages of living a normal life with hardly any monitoring, drink or diet restrictions .

    I think that a lot of people are put off by the lack of an antidote but it seems that is on the way shortly and also the chances of bleeding or an haemorrhage are less likely than on warfarin according to nice.

    I have had various other unrelated operations and merely stopped taking the tablets for a few days and the surgeons had no problem stopping bleeding. I have also cut myself numerous times through shaving, in the garden using an electric saw or cutting hedges but again no problem stopping the bleeding as before I started taking drugs.

    Everyone's different but maybe you should discuss your worries with your Dr. It is not fair that you should have to worry like that when their is an alternative on the NHS

    Keep going, you will find an answer soon

    BOL

  • Thanks for that. Yes, I'm seeing my GP next week. It has to be said that even if I was returned to normality I still wouldn't venture out anywhere remote on my own as I'm so reluctant to repeat some of the nasty little accidents I've already had. It's surprisingly easy to do something that takes months to heal.

  • Thanks for posting this link.I'd not heard of this before but it sounds amazing.I 'd be keen to have one fitted.

    Fi

  • Do look at Flapjack's write up of our meeting on this topic last week. One interesting point is that if you might need future/extra ablations it would be more difficult for them to ablate areas where the skin has grown over the device. It was said to stop 90% of the strokes originating in the left atrium but not suitable if one has problems in the ventricles as clots could form there- i e anti coagulants would still be needed,

  • Yeah, I do not think that they would treat anyone with that problem as it would be a waste

    Thanks for your input and keep well

  • Thank you very much for your response. There is obviously a bit more than what meets the eye rather than a television presentation, but it might give a bit of hope to some people

  • You know journalists. never let facts get in the way of a good story!

  • Herein the States, the watchman device is still being investigated and tested. It isn't widely available to AFib patients. I have a friend, who had a brain anurism ( ? spelling) that was resolved but she can't take a blood thinner who is waiting to see if she can be part of study testing it.

    Heather R

  • Just came across this and thought it might prove interesting to any of you who feel you can't take to warfarin, and are interested in the Watchman or left atrial appendage occlusion in general. markturnercardiologist.co.u... Mark Turner was the surgeon who put my ICD in after my collapse on the M4 just outside Bristol in March 2010 - my cardiologist in Gloucester was surprised that Mark should have undertaken such a 'little' job; I can understand his surprise now after reading about the man! I was in Bristol Heart Institute as an in-patient awaiting space in the theatre to have my ICD fitted and the first available slot just happened to be with one of their top surgeons. He did a very good job - very little bruising or pain, local anaesthetic, was awake all the time until they actually did a shock test, so can't speak highly enough of him.

    Cyril.

  • Thank you for that Cyril

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