Skip to Content

Menu Icon
Menu

Published on March 01, 2017

WATCHMAN Reduces AFib-related Stroke Risk Without Anticoagulation

Scott S. Chapman, MD, MBA

Scott S. Chapman, MD, FACC

Dr. Chapman earned his medical degree from the University of Nebraska College of Medicine, where he completed his residency in internal medicine and fellowship in cardiology.

North Kansas City Hospital is the first hospital in the Northland to use the WATCHMAN™ Left Atrial Appendage Closure Implant. This procedure reduces stroke risk in individuals with nonvalvular atrial fibrillation who are seeking an alternative to long-term anticoagulation therapy.

Scott S. Chapman, MD, FACC, an electrophysiologist, and David M. Hahn, MD, FACC, an interventional cardiologist, both with Meritas Health Cardiology, began performing the minimally invasive procedure in December 2016.

“This is really the first alternative proven to be safe in reducing the risk of stroke in patients who have a high risk of bleeding,” Dr. Chapman said.

Procedure

Once a patient is identified as a candidate, a specially-trained cardiologist performs a transesophageal echocardiogram pre-operatively to measure the LAA and determine the appropriate device size.

With this procedure, post-operative recovery is faster and easier than open-heart surgery. “Patients appreciate that there is very little pain or discomfort. They typically leave the hospital the day after and return to normal activities within one week,” Dr. Chapman said. “The goal, of course, is to get them to be able to stop their anticoagulation after 45 days.”

Candidates

The Watchman can reduce the risk of thromboembolism
from the left atrial appendage in patients.

The WATCHMAN device reduces the risk of
thromboembolism from the left atrial appendage in
patients with nonvalvular atrial fibrillation who are at
increased risk for stroke and systemic embolism based
on CHADS2 or CHA2DS2-VASc scores.

WATCHMAN candidates may have one or more of the following:

  • A history of bleeding complications with anticoagulation therapy
  • An inability to maintain a stable therapeutic International Normalized Ratio or to comply with regular INR monitoring, and unavailability of an approved alternative anticoagulation agent
  • A medical condition, occupation or lifestyle that puts the patient at high risk of major bleeding due to trauma

Clinical Trials

Several randomized trials have shown the efficacy and safety of the WATCHMAN. After 3.8 years of follow-up, the -procedure demonstrated statistically superior reductions in the risk of cardiovascular death, hemorrhagic stroke and all-cause mortality versus warfarin among patients with non-valvular AF at elevated risk for stroke.

“Even though warfarin was the medication that was studied and is the medication that is on the label for WATCHMAN, the standard of care has progressed to using any of the full-dose oral anticoagulants, including novel oral anticoagulants,” Dr. Chapman said.

Risks

He cautioned that any minimally invasive procedure has intrinsic risks, pointing to the risk of the implant causing pericardial effusion and dislodgement of the device that causes bleeding complications.

“These risks are low, and they are outweighed by the risks of being on long-term anticoagulation therapy,” Dr. Chapman said. “Patients with a higher risk of stroke and bleeding complications who are deemed safe to be on anticoagulation for 45 days are ideal for this procedure.”