anticoagulation after WATCHMAN device

Q; 64 years old male with a longstanding history of atrial fibrillation is admitted to ICU after WATCHMAN DEVICE implantation. Patient anticoagulation should be stopped onwards? 

A) True 

B) False 

 Answer: B 

 WATCHMAN device is a percutaneous closure of Left Atrial Appendage (LAA). It is advisable to continue anticoagulation for 6 weeks after the procedure with either warfarin (keeping INR 2-3) or direct oral anticoagulant (DOAC) plus daily aspirin (81 or 325 mg). 

If patient can't tolerate anticoagulation dual antiplatelet therapy (DAPT) should be kept on for one-six months (as per the clinician's discretion). Afterward, a patient can be managed only on daily aspirin. 

 It would be prudent to let the cardiology service manage the anticoagulation.

#cardiology

References:

1. Pacha HM, Hritani R, Alraies MC. Antithrombotic Therapy After Percutaneous Left Atrial Appendage Occlusion Using the WATCHMAN Device. Ochsner J. 2018;18(3):193-194. doi:10.31486/toj.18.0012 

2. Bergmann MW, Betts TR, Sievert H, Schmidt B, Pokushalov E, Kische S, Schmitz T, Meincke F, Stein KM, Boersma LVA, Ince H. Safety and efficacy of early anticoagulation drug regimens after WATCHMAN left atrial appendage closure: three-month data from the EWOLUTION prospective, multicentre, monitored international WATCHMAN LAA closure registry. EuroIntervention. 2017 Sep 20;13(7):877-884. doi: 10.4244/EIJ-D-17-00042. PMID: 28606886.

3. Enomoto Y and et. al. Use of non-warfarin oral anticoagulants instead of warfarin during left atrial appendage closure with the Watchman device. Heart Rhythm. 2017 Jan;14(1):19-24. doi: 10.1016/j.hrthm.2016.10.020. Epub 2016 Oct 19. PMID: 27771552.