Patient Profiles
Examples of WATCHMAN candidates
See which of your patients may be appropriate for WATCHMAN
Case study 1: Patient with previous major bleeding
Patient history
- 75F
- Patient has prediabetes, paroxysmal Afib, hypertension, CHA2DS2-VASc: 6-7, HAS-BLED: 4
- Year 1: Diagnosed with Afib, started apixaban 5 mg, twice a day
- Year 2: Afib ablation
- Early Year 3:
– Foot drop→ First hemorrhagic stroke
– CT scan found a hemorrhagic lesion
– Apixaban discontinued - Late Year 3: Headache, loss of balance →Second hemorrhagic stroke in same vascular bed
– During hospitalization, patient had pulmonary embolism (PE) and had an IVC filter (could not get anticoagulation due to recent hemorrhagic stroke).
Clinical challenge
Patient is at risk for stroke, has had a major bleeding event more than once and will not be able to withstand anticoagulation.
Patient criteria and therapy decision
Patient meets the criteria for having had a previous bleed, in this case a major bleed, and should be considered for WATCHMAN.
Case study 2: Patient with multiple conditions prohibiting anticoagulants
Patient history
- 65M
- Patient has Afib, atherosclerotic cardiovascular disease (ASCVD) (carotid, coronary, peripheral artery disease), hypertension, obstructive sleep apnea on CPAP and an aortic aneurism who presents for follow up of more frequent palpitations.
- Holter Monitor: ~20% burden of AF/AFL, longest episode duration of 12 hours and 22 min, fastest heart rate 169 bpm. Patient events correlated with mostly AF/AFL.
- Meets indication for "secondary" prevention ASA 81 mg given multiple vascular beds with ASCVD.
- Patient had severe epistaxis last year on apixaban requiring multiple blood transfusions. He is currently not on anticoagulation because of this.
Clinical challenge
Patient has concomitant medications and has had a minor bleed that could be considered significant because of the transfusions required. He should not be rechallenged with another anticoagulant, or discontinue aspirin, because of his vascular disease.
Patient criteria and therapy decision
- Patient has a history of minor bleeding and comorbidities that require treatments that may not be compatible with OAC.
- Patient can be considered for WATCHMAN based on bleeding history and clinical risk factors.
Case study 3: Patient at risk for future bleed
Patient history
- 75M
- Patient has chronic, persistent Afib (CHA2DS2-VASc=7), prior cerebrovascular accident (CVA), diabetes, coronary artery disease (CAD) after silent myocardial infarction (MI) who presented from his PCP.
- Had a CVA when he was off OACs for ENT surgery five years ago
- Labile INR with time in therapeutic range 20%
- Frequent falls
- Unable to afford apixaban
Clinical challenge
Patient has a history of falls, with low time in therapeutic range, and also struggles to afford his medication.
Patient criteria and therapy decision
The patient has frequent falls, low time in therapeutic range, is considered at high risk for future bleeds and is appropriate to consider for WATCHMAN.
Case study 4: Non-compliant patient
Patient history
- 77M
- Cigar smoker with history of mucosa-associated lymphoid tissue (MALT), prediabetes, hypertension (HTN), Afib on flecainide, sleep apnea, remote gastrointestinal bleeding, s/p implantable loop recorder (ILR) and GERD, presents for evaluation of post-COVID shortness of breath.
- Only taking ASA 325 mg
- CHA2DS2-VASc=4 (Age, HTN, non-obstructive coronary artery disease (CAD))
- Meets criteria for OAC, but declines
Clinical challenge
Patient is at risk for stroke but declines OAC.
Patient criteria and therapy decision
This patient struggles with OAC compliance but is at risk for stroke and is therefore appropriate to consider for WATCHMAN.
Case descriptions for educational purposes; not real patient cases.
For full information regarding WATCHMAN patient selection factors, please see the WATCHMAN Device Directions for Use (DFU).
See which of your non-valvular Afib (NVAF) patients may be eligible for WATCHMAN.
