Afib, strokes and bleeding: Enter the watchman

[yorkcardiology]

youtu.be/kFbJH437idw(Not working as expected?)

[Hilly22]

Thank you 😊

[Angie06]

This is really interesting for me as I was unable to take anticoagulants due to a risk of bleeding from cavernomas. I had my device fitted last year, on the NHS, at St Barts. However the Watchman was considered unsuitable for me due to sizing and an Amplatzer Amulet was fitted instead, no anticoagulants after just aspirin for 6wks and a TOE at 12wks when all looked to be fine. I certainly feel a lot less anxious now that the ectopics have settled and the risk of a clot has decreased but I'm wondering, and maybe Dr Gupta can throw some light, what the difference is between the two devices and if any long term effects from having a device like this?? When I say long term I mean 10yrs plus but I don't suppose anyone has had one for this length of time yet. 🤣

Angie

[dave205]

Thrombus on the Watchman LAA Occluder Tied to Higher Stroke Risk

Device-related thrombus mitigates the benefits of LAA closure relative to warfarin, but not relative to doing nothing at all, one expert says.

By Todd Neale May 14, 2018

BOSTON, MA—Patients who develop thrombus on the Watchman left atrial appendage (LAA) closure device (Boston Scientific) carry a greater risk of stroke or systemic embolism, and there are hints of a causal relationship, a new analysis shows.

Overall, 3.74% of patients in Watchman trials and registries had a device-related thrombus (DRT) detected, Vivek Reddy, MD (Icahn School of Medicine at Mount Sinai, New York, NY), reported at the Heart Rhythm Society 2018 Scientific Sessions here.

These patients had a more-than threefold increase in the risk of stroke or systemic embolism, as well as greater risks of major bleeding and hemorrhagic stroke. DRT was not associated with higher rates of cardiovascular or all-cause mortality.

How Does DRT Affect the Benefits of LAA Closure?

Serving as a discussant after Reddy’s presentation, David De Lurgio, MD (Emory University, Atlanta, GA), said, “DRT does continue to occur despite modifications of the device, despite increased training. It is something that is in the background and will be seen with the devices we know, including the Watchman device.

“What is a little alarming,” he continued, “is that the risk for DRT remains and extends well beyond the standard periods of anticoagulation, so there’s a big question about when are we out of the woods and is that something we can predict based on the patient profile or any other factors?”

De Lurgio pointed out that the factors associated with DRT in the current study parallel traditional stroke risk factors, “so that is maybe an insight into something we can do for these patients.”

He also alluded to the lower risk of intracranial hemorrhage that has been observed with the non-vitamin K antagonist oral anticoagulants (NOACs) when compared with warfarin to suggest another potential approach to improving outcomes in patients with DRT, who had higher risks of both ischemic and hemorrhagic stroke.

“The thought that there is an increased hemorrhagic stroke [risk], probably due to reinstitution of anticoagulation, does beg the question of whether there’s something we can do with different anticoagulants that are known to be associated with a lower intracranial hemorrhage should we see DRT,” De Lurgio said.

As for the impact of DRT, he said, “I do believe that DRT mitigates the benefits of left atrial appendage closure relative to warfarin . . . . However, it doesn’t mitigate the benefits of left atrial appendage closure with these devices relative to no therapy. And I think that’s a very important take-home message.”

tctmd.com/news/thrombus-wat...

[CTblood]

Thank you for this very interesting video. I have Hereditary Haemorrhagic Telangiectasia and recently diagnosed with persistent AF. I've just started taking Bisoprolol and my cardiologist has suggested fitting a Watchman.