Physicians from Doylestown Health's Richard A. Reif Heart Institute now offer patients with Atrial Fibrillation an alternative to blood thinners to help reduce the risk of stroke.
A new option for stroke prevention
For some patients with Atrial Fibrillation, taking a blood thinner was the only option to prevent stroke. Now, Doylestown Health physicians are offering an innovative device that can help prevent stroke without the need for blood thinners.
A team of cardiologists implanted the first Watchman device at Doylestown Hospital in early February 2016.
"The first patient is a 68-year-old male with AFib who had a previous stroke and suffered from repeated bleeding complications when he was taking the blood thinner warfarin," said electrophysiologist Robert Sangrigoli, MD. "The patient will take warfarin for just 45 days after implantation and then the medication is discontinued and should not be required ever again."
The Atrial Fibrillation-Stroke Connection
Atrial Fibrillation, or AFib, is the most common type of irregular heartbeat (arrhythmia) affecting an estimated five million Americans. During AFib, blood flow in the upper chambers of the heart is more stagnant, which can lead to the formation of blood clots. The tiny clots can travel from the heart through the blood vessels and clog blood flow to the brain, causing a stroke.
AFib is a major risk factor for stroke and heart failure. According to the National Stroke Association, about 15 percent of all people who suffer a stroke have AFib. People with AFib are five times more likely to have a stroke than people without the arrhythmia. Most often people are prescribed blood thinners like warfarin (Coumadin) to prevent blood clots and stroke.
The Downside of Blood Thinners
Not everyone can tolerate warfarin for a variety of reasons. The most common side effects are bleeding and bruising. Patients may also experience an intolerance to cold temperatures, fatigue, taste changes, numbness and tingling in their fingers and toes.
"The biggest concern is usually bleeding," said electrophysiologist John Harding, MD, of Doylestown Health's AFib Center. "Warfarin is also a difficult medication to regulate. There are many common drug and food interactions that require close monitoring of blood-thinning levels and frequent dose adjustments."
Patients taking warfarin need to have blood drawn at least once a month for testing to ensure safe blood-thinning levels. In some cases they may have to have a blood test once a week. While warfarin is an effective medication, many people don't like to take it or won't stick with taking the medication properly.
Most patients with AFib will likely require the medication their entire lives unless the AFib can be eliminated with an ablation procedure.
Breakthrough Alternative to Blood Thinners
With the Watchman, patients can safely stop taking warfarin and no longer feel its side effects while still reducing the risk of stroke. The Watchman device is permanently implanted in the left atrial appendage of the heart where blood clots often form. The fabric-covered device shaped like a parachute expands to close the opening of the appendage to prevent clots from leaving the heart.
Doctors implant the device using a catheter. The minimally-invasive procedure takes about an hour and usually requires a one-day stay in the hospital.
"We follow patients very closely soon after implantation with phone calls, office visits and an echocardiogram or ultrasound of the heart 45 days later to make sure the device has healed well into position," said Dr. Sangrigoli. "Once we are certain of this we stop the blood thinner and continue close follow-up as needed."
Approved by the FDA in March 2015, the Watchman device has been tested against warfarin and is at least as effective as warfarin at reducing the risk of stroke. Newer blood thinners (like Xarelto or Pradaxa) are also associated with bleeding risks. If a patient cannot safely tolerate one of the newer blood thinners, they may also be a candidate for the Watchman device.
"Performing this procedure allows us to offer patients with high risk of stroke as well as high risk of bleeding complications an alternative option to prevent future strokes," said Dr. Harding. "It adds to the variety of state-of-the art treatments available at our AFib Center. We can offer patients a complete range of treatment options from stroke risk reduction to treatment and correction of AFib itself."
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