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A-Fib-Related Stroke Risk: Watchman Better Than a Lifetime on Warfarin

Background: The most prescribed anticoagulant, warfarin, reduces the A-Fib-related risk of stroke by 60% to 70%. Most A-Fib clots (90%-95%) come from the Left Atrial Appendage (LAA).

An alternative to anticoagulants, the Watchman occlusion device closes off the LAA. FDA approved, it’s a very low risk procedure that takes as little as 20 minutes to install. Afterward, you would usually not need to be on blood thinners.

CT brain with Ischemic stroke at A-Fib.com

CT brain with Ischemic stroke

Effects of a Lifetime on Warfarin

Warfarin (brand name Coumadin) and other anticoagulants work by causing bleeding and are inherently dangerous.

Among other bad side effects, long-term use of anticoagulants such as warfarin have been known to not only cause hemorrhagic strokes, but also microbleeds in the brain leading to dementia. (For more, see Patient on Anticoagulation Therapy for 10 Years Develops Microbleeds and Dementia).

A 2015 study found evidence of microbleeds in 99% of subjects aged 65 or older. When imaging strength was magnified, even more microbleeds were detected. Microbleeds are thought to be predictive of hemorrhagic stroke.

Conclusion: according to current research, to reduce microbleeds, ditch the anticoagulants. You’d do better having a Watchman device installed than spending a lifetime on warfarin.

Note: there’s no guaranteed way to avoid a stroke altogether.

What About the New Anticoagulants (NOACs)?

Does this research apply to the new anticoagulants like Pradaxa, Xarelto, Eliquis and Savaysa/Lixiana? Technically no. This research only applies to warfarin.

But intuitively one would expect the same general principles to apply. All anticoagulants cause bleeding. That’s how they work.

Caveat—Long-Term Effects of Watchman?

Catheter positioning the Watchman occlusion device at the mouth of the Left Atrial Appendage

Catheter placing Watchman in LAA

What are the long-term effects of leaving a mechanical device like the Watchman inside the heart? We know that, after a few months, heart tissue grows over the Watchman device so that the LAA is permanently closed off from the rest of the heart.

It seems unlikely that complications would develop after a long period of time as has happened with warfarin. But we can’t say that for sure until enough time has passed. The first clinical trial installation of the Watchman device in the US was in 2009 and in Europe in 2004. So far, no long-term complications have developed.

EPs Installing the Watchman Device

Want to learn more about the Watchman? See my article, The Watchman™ Device: The Alternative to Blood Thinners.

To find EPs installing the Watchman, I highly recommend selecting an electrophysiologist (EP) who is certified in “Clinical Cardiac Electrophysiology”. For a list of EPs meeting this criteria, see Steve’s Lists of A-Fib Doctors by Specialty: Doctors Installing the Watchman.

References for this article

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