From the Research
After Watchman device placement, the recommended anticoagulation regimen typically involves a transition from oral anticoagulation to dual antiplatelet therapy (DAPT), with a recent study suggesting half-dose direct oral anticoagulation (DOAC) as a viable alternative to standard antithrombotic therapy 1.
Key Considerations
- The most recent and highest quality study, published in 2021, evaluated the long-term efficacy of a standard antithrombotic strategy versus half-dose DOAC after Watchman implantation, finding that half-dose DOAC significantly reduced the risk of device-related thrombosis and major bleeding events 1.
- Initially, patients should be prescribed a DOAC such as apixaban or rivaroxaban for 45 days post-procedure, followed by DAPT consisting of aspirin and clopidogrel for 6 months, and then aspirin indefinitely if a repeat transesophageal echocardiogram (TEE) confirms adequate seal.
- The use of half-dose DOAC, such as dabigatran, may be considered as an alternative to standard antithrombotic therapy, particularly in patients with high bleeding risks.
Anticoagulation Regimen
- The anticoagulation regimen should be tailored to the individual patient's risk factors and medical history, with consideration given to the use of half-dose DOAC as a viable alternative to standard antithrombotic therapy.
- The regimen should balance the need for stroke prevention with the risk of bleeding as the Watchman device becomes fully incorporated into the left atrial appendage.
Monitoring and Follow-up
- Patients should be closely monitored for device-related thrombosis and major bleeding events, with regular follow-up appointments and imaging studies as needed.
- The first imaging post-Watchman implantation can be delayed to 4 months, as this period is not associated with an increased risk of ischemic stroke 2.