From the Research
Dual antiplatelet therapy (DAPT) is typically recommended for 6 months after Watchman device implantation, consisting of aspirin 81-325 mg daily plus clopidogrel 75 mg daily, with a follow-up transesophageal echocardiogram (TEE) at 45-60 days to confirm adequate device endothelialization and absence of device-related thrombus. The most recent and highest quality study, 1, suggests that antithrombotic therapy with aspirin and clopidogrel for six months followed by daily aspirin indefinitely may be feasible for patients with an absolute contraindication to oral anticoagulation.
Some key points to consider:
- The duration of DAPT may be shortened in patients with high bleeding risk or extended in those with delayed endothelialization or other risk factors 2, 3, 4.
- Regular follow-up with a cardiologist is essential to monitor the effectiveness of the therapy and make any necessary adjustments 5.
- The use of DAPT after Watchman implantation in patients with high bleeding risks has been a source of debate, and more research is needed to tailor the existing antithrombotic regimen to the needs of patients 1.
In terms of specific patient populations, those with a history of bleeding or high bleeding risk may require a shorter duration of DAPT, while those with delayed endothelialization or other risk factors may require a longer duration. Ultimately, the decision on the duration of DAPT should be individualized based on the patient's specific risk factors and clinical presentation.