From the Research
After Watchman device implantation, Eliquis (apixaban) should be continued for 45 days, as this duration is crucial for preventing device-related thrombus formation while endothelialization of the Watchman device occurs 1. The standard dosage of Eliquis during this period is 5 mg twice daily, though some patients may require a reduced dose of 2.5 mg twice daily based on age, weight, or kidney function. Some key points to consider in the management of patients post-Watchman implantation include:
- The use of anticoagulants after WATCHMAN implantation in patients with high bleeding risks has been a source of debate 1.
- Dual antiplatelet therapy (aspirin plus clopidogrel) for 6 months, followed by lifelong aspirin therapy, is a common regimen after the initial 45-day period of Eliquis 2.
- Transesophageal echocardiography at around 45 days post-implantation is essential to confirm proper device placement and absence of peridevice leaks before transitioning from Eliquis to antiplatelet therapy 3.
- The choice and duration of drug therapy for device-related thrombus may involve the use of apixaban, as demonstrated in a case report where apixaban successfully treated device-related thrombus 4.
- The WATCHMAN device has been shown to be noninferior to warfarin in preventing embolic events, with a potential advantage in terms of functional outcome for patients 5. It is essential to monitor patients closely and adjust the anticoagulation regimen based on individual bleeding risk, comorbidities, and specific clinical circumstances.