Atrial fibrillation (AFib) is a heart rhythm disorder that affects some 2.2 million people in the United States. With AFib, the two upper chambers of your heart beat irregularly, possibly leading to blood clots and weakening your heart over time. You may experience anything from shortness of breath to heart palpitations. Or you may experience no symptoms at all. Without treatment, though, you could risk stroke or even heart failure.
Treatment for AFib and blood clots
The main goal of treatment for AFib focuses around controlling your heart rhythm and preventing blood clots. Preventing clots is extremely important because they can dislodge and travel to other parts of your body. When a blood clot goes to your brain, it may lead to stroke.
Traditional therapies revolve around medications, like blood thinners.
Warfarin (Coumadin) is the most commonly prescribed blood thinner for AFib. It may interact with certain foods and medicines, so it’s not an option for everyone. It may also lead to complications like excessive bleeding. If you take this medication, you’ll need frequent monitoring through blood tests.
Newer drugs — dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis) — are just as effective as warfarin. They may even lead to less intracranial bleeding, or bleeding inside your skull. These medications are shorter-acting, which means you don’t need to have your blood monitored as closely while taking them. They also don’t interact with as many foods and other medications.
Along with the risk of bleeding and interactions, one downside of taking medication to prevent blood clots is having to take it long term. You may not want to be on a medication for the rest of your life. You may not want to go to your hospital every week to have your blood tested. Or you may have other complications or conditions that make taking these medications for the long haul unappealing or even impossible.
Implant alternatives to medications
If you’re looking for an alternative to taking blood thinners, implant devices like the WATCHMAN may be worth investigating. This device blocks off the left atrial appendage (LAA) — the area in your heart where blood often pools and clots. In fact, the clots that cause stroke in people with AFib develop in this area 90 percent of the time, according to a 1996 study.
The WATCHMAN is approved by the U.S. Food and Drug Administration (FDA) for people who have AFib that doesn’t involve a heart valve, referred to as nonvalvular AFib. It’s shaped like a tiny parachute and is self-expanding. Once in place, tissue will grow over the WATCHMAN in around 45 days to block off the LAA.
To be eligible to have this device implanted, you should be able to tolerate blood thinners. You can’t have an existing blood clot in your heart or an allergy to nickel, titanium, or any other material in the device.
The WATCHMAN is inserted during an outpatient procedure through a catheter in your groin that is then fed up into your heart.
Like the WATCHMAN, the LARIAT is an implant device that helps prevent blood clots from forming in your LAA. The LARIAT ties off the LAA using sutures. Eventually, it turns into scar tissue so blood is unable to enter, collect, and clot.
The procedure is also performed using catheters. The LARIAT is made up of a soft plastic catheter tube. The tube has magnets as well as a lasso- or noose-shaped end. This is the suture that will eventually tie off your LAA. Only small punctures are needed to place this device versus a large incision.
The LARIAT is approved for people who don’t have success with blood-thinning medications and those who can’t undergo surgery for whatever reason.
Effectiveness of implant devices
After 45 days, some 92 percent of people with the WATCHMAN were able to go off blood-thinning medications in clinical trials At the one-year mark, 99 percent of people were able to go off blood thinners.
The LARIAT procedure may reduce your risk of stroke by between 85 and 90 percent.
In comparison, risk of stroke while on blood thinners is reduced by around 80 percent.
Besides effectiveness, one of the main benefits these implant devices share is that they can be placed in your body without invasive surgery. In fact, in most cases people go home the day of the procedure. Before these types of implants, the LAA would be tied off through open-heart surgery.
This means that you’ll likely have a quicker recovery with either the WATCHMAN or LARIAT. Your level of pain and discomfort should also be minimal.
These devices may allow you to gain independence from blood-thinning medications. They are just as effective — if not more so — as warfarin and other drugs. They offer protection without the danger of bleeding and the difficulty of managing long-term medication. This is great news if you have issues taking anticoagulants or wish to avoid the risks of excessive bleeding.
The takeaway: Speak with your doctor about implants
Unhappy with your blood thinner? There are alternatives. If you’re interested in learning more about how these implant devices may work for you, contact your doctor to make an appointment. They’ll let you know if you’re a good candidate for implants, as well as give you more details about the procedures and answer any specific questions you may have.