Emerald Coast Heart & AFib
Atrial fibrillation (AFib) significantly increases stroke risk, but the good news is that we have powerful tools to prevent strokes and protect your brain.
For years, the only option for stroke prevention in AFib was long-term blood thinners (anticoagulants). Now, there’s an innovative alternative — the Watchman Left Atrial Appendage Closure (LAAC) device, which reduces stroke risk without the need for lifelong blood thinners.
Which option is right for you? Let’s explore both blood thinners and the Watchman so you can make an informed decision with confidence.
When the heart beats irregularly in AFib, blood can pool and form clots, especially in a small pocket of the heart called the left atrial appendage (LAA). If a clot breaks loose, it can travel to the brain and cause a devastating stroke.
Without treatment, AFib increases stroke risk by 5X!
🔹 The Solution? Blood thinners! Anticoagulants prevent blood clots from forming, drastically reducing stroke risk.
AFib increases stroke risk, so treatment decisions are based on the CHA₂DS₂-VASc Score:
| Risk Factor | Description | Pts |
|---|---|---|
| C | CHF/LV dysfunction | 1 |
| H | Hypertension | 1 |
| A2 | Age ≥75 | 2 |
| D | Diabetes | 1 |
| S2 | Stroke/TIA/TE | 2 |
| V | Vascular disease | 1 |
| A | Age 65-74 | 1 |
| Sc | Sex (female) | 1 |
Score = 1 (Men) or 2 (Females), consider anticoagulation
Score ≥ 2 (Men) or ≥3 (Women), anticoagulation is recommended unless contraindicated
Higher total scores increase your risk of stroke each year
There are four main oral anticoagulants used in AFib:
| Medication | Typical Dosage | Key Interactions | Main Bleeding Risks |
|---|---|---|---|
| Eliquis (Apixaban) |
5mg twice daily (2.5mg if specific criteria are met) |
Grapefruit, NSAIDS, Certain antibiotics, antifungals, and HIV meds |
GI Bleeding – melena (dark, tarry stools) – bright red blood in stool Hematuria – blood in urine Excessive bruising Brain bleeding (more common with Warfarin) |
| Xarelto (Rivaroxaban) |
20mg daily with supper (15mg if kidney disease) |
Grapefruit, NSAIDS, certain antibiotics, antifungals and HIV meds | |
| Pradaxa (Dabigatran) |
150mg twice daily 75mg if kidney disease |
Rifampin, NSAIDS, aspirin | |
| Warfarin (Coumadin) |
Variable – requires routine INR monitoring | Leafy greens, alcohol, antibiotics, grapefruit – get a list…a lot of interactions! |
💊 Missed doses lead to increased stroke risk.
🚨 High rates of discontinuation (up to 30% of patients stop within a year!).
❌ Bleeding concerns – blood thinners can increase the risk of major bleeding, including gastrointestinal (GI) and brain bleeds.
These are signs to seek immediate medical attention
How Does AFib Cause Stroke? The Role of the Left Atrial Appendage (LAA)
92% of AFib-related strokes originate in the left atrial appendage (LAA)!
The LAA is a small pouch in the heart where blood clots form. If we can seal off this area, we can stop clot formation—without needing blood thinners. That’s exactly what the Watchman does!
The Watchman is a small, umbrella-like device that permanently closes off the LAA, reducing stroke risk without anticoagulation.
The Watchman is FDA-approved for patients with nonvalvular AFib who need an alternative to blood thinners.
CHA₂DS₂-VASc Score of 2+ (men) or 3+ (women) and a reasonable rationale to seek an alternative to blood thinners such as:
History of major bleeding or high HAS-BLED Score
Difficulty tolerating blood thinners (bleeding risk, falls, ulcers, long-term compliance issues)
Kidney disease limiting anticoagulant use
History of GI bleeds or brain bleeds
Active lifestyle or job with high bleeding risk
Minimally invasive, done under sedation
A thin catheter is guided through a leg vein in the groin to the heart
The Watchman is placed in the left atrial appendage
Takes less than an hour, and patients go home the same or next day!
First 45 Days: Short-term blood thinners (Eliquis, Xarelto, or Warfarin), then aspirin/Plavix until 6 months post implant then only Aspirin
or
First 6 months: Aspirin/Plavix
Long-Term: Aspirin only—no blood thinners needed!
The bottom line? The Watchman provides stroke protection equivalent to blood thinners—without the lifelong bleeding risk.
If you’re at high risk for bleeding, have had issues with blood thinners, or simply want a permanent solution, the Watchman may be the best stroke prevention option for you!
Call us today to discuss your personalized AFib treatment plan! ❤️
