results of echo because of fast hearts seen on last remote transmission

The stroke reduction benefits of modern anticoagulants are well proven

by crustyg - 2021-07-13 12:30:45

IIRC, the clinical trial benefits (in terms of stroke reduction) of apixaban is the best of the novel anticoagulants (NOAC), and all of the NOACs have a very good safety record for extremely low risk of major bleeds (esp. GI, but also including intracerebral bleeds).  Easy to take, not affected by diet, easy to reverse (in case you're in a smash), few side effects, and easy to switch to another if this becomes necessary: for most folk in the USA the biggest factor is cost.  A realistic price for Apixaban is about £50pcm (what the UK NHS pays): I've heard horror stories of folk paying $500pcm in the USA.

The only people who *enjoy* taking medications, we doctors call hypochondriacs.  No-one *likes* taking medication but if it prevents you from having a stroke (or a series of strokes), why resist?

There are *lots* of conrtibutors here on NOACs and a few with Watchman.

Anticoagulant or Watchman device ?

by Gemita - 2021-07-13 14:10:29

new to pace,

Firstly, I am sorry you are in this position of having to choose between a Watchman device and an anticoagulant for AF/Flutter.  I know them both well (the AF/Flutter) and even a brief run of either can put us at risk for a stroke, so I am glad you have received good advice.

I am not confident that the Watchman Device can prevent a stroke as well as the newer novel anticoagulants (NOACs) or even Warfarin and my doctors would not recommend Watchman unless I had had a serious bleed or there was some other contraindication to taking the NOACs.

But I am not trying to influence your decision new to pace because you know yourself best.  All I can say to you is that I have the most sensitive digestive system and really suffer when I have to take meds.  However, I can honestly say that swallowing my anticoagulant has caused absolutely no side effects and I have been on it for over three years.  The four main ones out there:  Apixaban, Edoxaban, Rivaroxaban, Dabigatran have slightly different safety profiles.  I was told by my clinic that Apixaban was probably the safest of them all in terms of bleeding risk, especially for a gastric bleed.  Hubby and I both tried Apixaban 5 mg, 2 x daily (which is the therapeutic dose for stroke prevention) but the twice daily dosing and 10 mg total medication was still too high for both of us.  This caused urinary bleeding (gross) husband and gastric distress in my case. The lower dose of Apixaban 2 x 2.5 mg/daily wouldn't have been a therapeutic dose for AF stroke prevention, so our clinics switched us to low dose, once daily dosing (30 mg) Edoxaban which is apparently therapeutic, because of low body weight (less than 60 kg, me) and reduced kidney function (hubby).  We have been absolutely fine on it for 3+ years.  No side effects whatsoever.  I don’t even know I am taking the med.  Quite incredible and I was petrified of taking an anticoagulant.  Hubby has had strokes (prior to Edoxaban) and bleeds (prior to Edoxaban) and he has been absolutely fine on 1 x 30 mg daily Edoxaban.

So in my case, it was easier for me to choose the oral anticoagulant.  No fuss, no bother, no side effects.  No procedure was necessary.  A procedure always carries a risk, however low, like bleeding and I was also told about the risk within the first few months of device-related thrombus and the need for checks (involving a TEE - trans oesophageal echocardiogram).  They also told me I would need dual antiplatelet therapy (aspirin/clopidogrel) until 6 months after LAA (left atrial appendage) closure  or a short course of an anticoagulant, so the Watchman has its disadvantages.  

You could try an anticoagulant first.  If you cannot tolerate it, then ask for the Watchman device?  They might want you on an anticoagulant in any event before the procedure (heart catheterization), so you could trial an anticoagulant?   I think often the fear is worse than the reality new to pace.  It took me 6 months to make a decision, but I needed 6 months, even though my doctors were losing patience with me and telling me I was at risk of a stroke the longer I procrastinated.  They also said without anticoagulation, they would not treat my AF with say, an ablation, so I felt forced into a decision, but I made the right decision for me.

I wish you well new to pace.  Do lots of research.  That is what I did and it helped me a great deal.  Private message me if you need any further support.  A big decision, I know

https://www.rbht.nhs.uk/our-services/left-atrial-appendage-occlusion-device

thanks

by new to pace.... - 2021-07-13 14:44:02

Thanks, Crustyg and Gemita  I will study this carefully some more.  I know when i was first told of the Watchman was at the same time getting  told i needed a Pacemaker implanted in August 2019.

  Been reading up on Watchman says i will need 45 days of Warfarin after the surgrey.  Which does not make me happy.  Since the reason for this was to avoid  the use of drugs.

new to pace

Apixaban

by Prof P - 2021-07-13 18:08:00

I agree that researching and knowing yourself makes sense.  Apixaban is effective but not inexpensive.  I have been taking it for about 2 years with zero side effects (2 x 5mg daily).  In the US, costs can be as stated although insurance coverage can reduce these costs to the $US 35 range per month (or less).  It seems to be easy enough to tolerate, but none of us likes taking medications.  But, controlling the stroke risk seems to make sense for those of us with AFIB and pacers.  

NOAC vs. Watchman

by AgentX86 - 2021-07-13 18:25:04

I agree with the others.  NOACs are a no-brainer.  The cost is ridiculous but Medicare picks up most it.  If you're not taking any other drugs and have no Part-D plan, it's going to set you back.  If you do, it will certainly guarantee you a trip through the donut hole.  But what is your life, or worse, worth?

90% of the ischemic strokes seen in Afib patients is from the LAA.  The Watchman only closes the LAA, which leaves you with 10%.  That certainly tilts the calculus when brain-bleeds caused by anticoagulants are taken into account but I don't like the odds.  I have permenant flutter and a clipped LAA - not good enough for my EP.  A clipped LAA is better than any Watchman, which do leak.  You'd have to have a TEE to verify any leaks were small enough.

Being afraid of meds is a modern luddism, IFAIC (no different than the anti-vaxers).  "Healthy" diets can only go so far.  Do the NOAC. 

thanks

by new to pace.... - 2021-07-13 20:43:57

thanks Prof P and  AgentX86.  have done more research and so far have come up with these as a maybe Edoxaban and Dabigatran as the others contain Lactose.  which i cannot tolerate.

new to pace

Apixaban

by Julros - 2021-07-13 22:09:25

I too take apixaban and with my insurance I pay $35 /mo. I have taken a couple of big spills on my bike that created some big bruises, and some abrasions, but there was no issue with stopping bleeding.My dad took warfarin for years and could never maintain a therapeutic level, and he got so tired of the blood draws.  

I will gladly trade a few bruises to prevent another stroke. And the insertion of a Watchman is invasive, which carries the risk of infection. 

Apixaban

by NormaLou - 2021-07-14 20:14:23

I have been on Apixaban for nine months with no side effects or inability to control bleeding, since I do cook a lot and have had a couple minor cuts. (Which for me is not unusual. lol) My hubby started on Apixaban about a year ago. He has also experienced no side effects. He works on cars and is constantly bumping (bruising) himself or getting a hand cut. The bleeding has not been a problem. We just clean it up with alcohol and stick a bandaid on and off he goes. Hope this helps.

apixaban etc.

by new to pace.... - 2021-07-14 22:37:09

Thanks all for letting me know you do not have any problems.  My biggest concern with most of these is they are coated in Lactose.  I cannot tolerate Lactose cuases me to bloat.  Have been down that road before and it was not pleasant.

Heard from my Primary care Dr. who said  because of my history of GERD and peptic ulcers the watchman might be a better.  Can start with the the anti coag and then later If need be can get the watchman.

Also wrote to the EP and asked him how many Watchman's he has done.  

new to pace

apixaban etc

by AgentX86 - 2021-07-15 16:21:51

It seems, while there seems to be some link between Eliquis and lactose intolerance, it's certainly not a given (it doesn't contain lactose).  It looks to be pretty low probability, 39 cases out of 107,000 reporting ("<0%").  I'd rather not have the alternative.

I didn't look up the others.

<https://www.ehealthme.com/ds/eliquis/lactose-intolerance/>

watchman

by new to pace.... - 2021-07-15 20:09:23

Heard from the EP's nurse said he has done well over 400 implants and is done in 15 minutes and most go home the same day.

new to pace