Written on behalf of the Sanger Heart and Vascular Education Group
An 80-year-old female patient with known atrial fibrillation (AF) and a CHA2DS2-VASc score of 4 is admitted to the medical intensive care unit with a life-threatening gastrointestinal (GI) bleed. No clear GI source of blood loss is found. You are asked to render an opinion regarding restarting anticoagulation.
Regarding the WATCHMAN (Boston Scientific; Marlborough, MA) device now being used widely in the treatment of patients with AF who may no longer be suitable for long-term anticoagulation, which of the following is true?
Show Answer
The correct answer is: C. Patients must be able to take warfarin or a novel oral anticoagulant for a minimum of 45 days post-implant; following this, a single-agent antiplatelet strategy is used for the long term.
The WATCHMAN device is a newer technology to treat patients with AF at high risk for stroke who are no longer able to take a long-term anticoagulant (e.g., prior bleeding on anticoagulation or inability to regulate warfarin levels). Neither left atrial size nor degree of mitral regurgitation is a contraindication for a WATCHMAN implant. Patients must be able to take warfarin or a novel oral anticoagulant for 45 days post-implant before a single agent, aspirin, can be used long term. Performing a computed tomography and transesophageal echocardiography for device selection is not necessary.
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