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My 89 year old husband has AFIB. He is on Eliquis. His new Cardiologist has recommended inserting a device in his heart called WATCHMAN, which is a left appendage closure device. The doctor said that if it is inserted, he can get off blood thinners. I had never heard of it and I wonder if anyone on this forum has. As far as I know he would not be put out all the way, just a local anesthetic, like you would get when they do a Angiogram.


Since Hubby is in the middle stages of Alzheimer's, I don't think I would be interested if they put him to sleep because I hear that is not good for dementia patients.

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OY. YEs I have heard of it because they even had some commercials a while back. I would start by wondering if the MD has any conflicts of interest with this device or the company that makes it. I would be getting a 2nd and even 3rd opinion before going forward. If he's already in the so called mid stage of Alzheimers, I wonder how much worse exposure to anesthesia would make it? Or not? As in it may not make much if any difference.

My dad at Age 100 had 20 some years earlier had a CABG surgery and was going strong...but one day he didn't feel too great and wanted me to make an MD appt. Due to a cancellation he was able to be seen the next day....and his heart rate was 35. He was they said in heartblock, and was taken to the nearest hospital where the next day they put a pacemaker in. But what they didn't educate us about prior was that while he was quite stable at 35 BPM, they could not risk adequate anesthesia for fear they would lose him...so his memory holds this experience which turned out to be quite traumatic...being virtually wide awake while they slashed his chest open to put it in. Had we known, I don't know what we would have done. THis IS a reputable facility and the MD was quite well regarded....we might have found another MD for a 2nd opinion. My dad being my dad, the procedure was done about noon and at 2 PM he was back in his room eating a sandwich. Just beware...
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Reply to gdaughter
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The WATCHMAN reduces risk of blood clots and tissue death (especially heart and brain) and can be implanted under conscious sedation. It will not reduce, but not stop, clot formation in the rest of the body, just that one area, Long term blood thinners can be a problem for seniors with risks of falls, injury and forgetting to "protect" themselves from bleeding.

If it was my husband, I would opt for the device so he could get off the blood thinners - and all the associated risks with being on blood thinners long term.
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Specialist MDs have great knowledge about their own area. And our insurance systems pays for procedures. So it is fine to decline a procedure, especially one such as this one which require some sedation.
Specialists also tell patients that they must continue a certain medication every day or they will have another stroke/heart attack.
If you are both looking at quality of life, then more procedures may not be the way to go.
You know him best, and you know what you can manage. Please dont let anyone, MDs included, try to make you feel that you are being neglectful by declining treatment for him. Good luck.
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Reply to Clairesmum
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That is what this Watchman does. I am sorry I don't remember, does your husband have dementia? Was the procedure done before or after diagnosing if he has it.
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Maple3044 Aug 14, 2021
Hubby has dementia. He has had chronic AFib for over 12vyears. He was scheduled for it, but decided not to. I couldn't talk him into it. His cardiologist said to let him alone, as he didn't see forcing my hubby to get it. PS MY hubby is 81.
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My husband was evaluated for it after he fell and developed a subdural hematoma. He was taking Prada a for his chronic Afib. The procedure to insert is similar to a heart cath, where they insert a thin wire thru the artery or vein in the groin. The device closes off the little pocket in the heart where most blood clots occur.
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It may however keep him alive which has to be weighed against the potential risks of anesthesia. It is a procedure usually done under light general anesthetic (mainly to keep patient immobile) as it is a small device delivered to the heart via a small incision in a major vessel and guided up to where it needs to sit. It is very common to stop blood clots forming in the heart which can then go on and cause a stroke. Of great benefit to those for whom blood thinners are not having a nice smooth effective result. If blood thinners do the job fully not much point but if they are not providing a level improvement then the Watchman is a simple way to block clots forming and to get off blood thinners.
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MaryKathleen Aug 11, 2021
So far he seems to be doing OK on Eliquis.
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I'm not familiar with it.  My father had a pacemaker that was periodically replaced.  He did take Warfarin/Coumadin and after discussion with med pros in the Anti-Coagulation Clinic, we decided against the newer meds such as Eliquis, and stuck to Warfarin, since it could be monitored easily. 

Given that he had one episode of over anti-coagulation b/c a PCP ignored the med list I gave and prescribed a med that caused anti-coagulation, we were both leary about trying something that didn't require regular monitoring of PT/INR levels.

Boston Scientific makes it; I believe it was the maker of my father's pacer as well.   

You might want to check with his previous cardiologist, unless there were negative reasons for switching to the new doctor.
 
I did  a quick check for class action lawsuits, adverse actions, etc. and found this 2019 article on side effects and negative aspects.  It is of interest, and I would consider it seriously, perhaps doing more research.

https://www.nationalinjuryhelp.com/watchman-stroke-device-lawsuit/
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MaryKathleen Aug 11, 2021
GardenArtist, and I wish i was one. Hubby is the garden artist in our little family. He is fading and it looks like i am going to pull weeds and try to talk him into letting me hire some of the hard work out.

There were negative reasons we changed. I wouldn't ask his old doctor for the time of day. To be honest about half of my problems was with the office staff.
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Think long and hard about how much medical intervention you want to do on an 89-year-old man with Alzheimer's. He will unquestionably take a dive after the procedure, and will this device (which I know nothing about) make him live longer only to go farther into the depths of dementia? How will it add to the quality of his life?

I'm not making a judgement here, but just suggesting you look at all the angles. Just because the treatment is there doesn't always mean it's the best treatment for the best outcome.
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MaryKathleen Aug 11, 2021
Mj1929, you have that right. Both of us are firm believers in the quality of life and I am concerned about his mental health if he goes under anesthetic . They were a little pushy in the doctor's office, and that always puts my back up.
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Hi MaryKathleen,
I'm familiar with it. Here's a video from the makers of the device
https://youtu.be/Gt5Sz8FR7JM
The data on the procedure so far looks fairly good (https://www.tctmd.com/news/low-1-year-stroke-risk-after-commercial-watchman-use)
Post procedure there is still a need for some type of blood thinners for the first 30-45 days or so while the device settles in-once a good seal is confirmed by a follow-up echocardiogram they will decide what meds they want to continue for up to 6 months, usually something like aspirin, plavix, or eliquis.
The places I am familiar with use an anesthesiologist for these procedures, since they confirm the position of the device with an echocardiogram probe that the patient swallows. That requires more sedation than for something like an angiogram. For an angiogram, the patient is relaxed, or awakens to verbal stimuli, for an LAAO procedure your husband would be soundly asleep, but still breathing on his own-not intubated. You might want to confirm with the cardiologist what their practice is at their facility and discuss concerns about sedation sequelae. Good luck!
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MaryKathleen Aug 11, 2021
I am also going to mention the potential problems to his Alzheimer's specialist and his primary doctor.
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Here is a link to an interesting article & video about the Watchman device:

https://www.watchman.com/en-us/how-watchman-device-works.html

My DH had a pacemaker installed in 2019 under local anesthetic and he felt no pain during the procedure or afterward, and the PM has kept him alive, literally.

On the other hand, my 94.5 y/o mother has AFIB and was on blood thinners for 7 years; they began causing her more harm than good when she started developing the worst nosebleeds the ER doc had ever seen. The last of the 4 she had, I arrived in the ER to see the doctor photographing the clot that came out of her nose which was the size of a plum. He was going to post it on the bulletin board for the whole staff to see. I got mom off of Xarelto the next day. She did have a mild stroke the CT Scan said some time afterward, so there's that. She also has moderately advanced dementia nowadays and no lifesaving measures are being taken b/c her quality of life is very compromised at this point.

Wishing you and DH the best of luck with your decision.
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MaryKathleen Aug 11, 2021
Thanks lealonnie1, I will look that up. I did look on YouTube and found some good information there. Both of us are firm believers in the quality of life. Right now he says he doesn't want it. Because he is saying no to everything except his dentist, I am trying to decide if I need to try to talk him in to it. I think I have finally talked him into getting new glasses. He doesn't want to spend money, he has enough but he is just at that stage.
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You need to balance things like when his dementia causes him to refuse his blood thinner. Or if he has trouble swallowing. Then it will become a stroke ready to happen.
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TaylorUK Aug 11, 2021
This is a good point. Once a watchman is fitted it removes the need for medication that can become quite a fight and distressing for someone with dementia - keeping a stroke at bay and not having the giving of medication to someone with dementia has to be a big plus on both counts.
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