Watchman or Warfarin? Choosing a Method of Stroke Prevention

Could a tiny device designed to avert stroke-provoking clots be a substitute for medication? The technology is an option for certain at-risk patients.

8:00 AM

Author | Jane Racey Gleeson

For certain non-valvular atrial fibrillation patients who do not respond well to (or are at risk from) taking warfarin, a lightweight heart implant the size of a quarter has been hailed as a feasible alternative.

In recent trials, researchers found a clot-stopping device known as the Watchman was comparable to warfarin in offering effective protection from disabling stroke, hemorrhagic stroke and cardiovascular death.

"This is certainly something that can and should be considered," says Hakan Oral, M.D., a cardiologist at the University of Michigan Frankel Cardiovascular Center — one of the first facilities in the nation to use the pioneering device. But it's not right for everyone.

How the Watchman works

The Watchman is inserted with a wide-sheathed catheter placed through an incision in the patient's upper leg. Once in place, the self-expanding device is opened (similar to an umbrella) to seal off the heart's left atrial appendage, where harmful blood clots can form and then enter the bloodstream, thus reducing the risk of stroke and other systemic embolization.

The device bears a surface covered with a thin, permeable filter, allowing blood to pass through while simultaneously stopping clots. A patient's own heart tissue will grow over the permanent implant in time.

The Watchman comes in several sizes (as large as 33 millimeters) to accommodate individual left atrial appendages.

Who is a candidate?

A team of specialists determines whether patients are eligible for the device.

According to the Food and Drug Administration (PDF), the Watchman is indicated to reduce the risk of thromboembolism from the left atrial appendage in patients with non-valvular atrial fibrillation who:

  • Are at increased risk for stroke and systemic embolism based on CHADS2 or CHA2DS2-VASc scores and are recommended for anticoagulation therapy;

  • Are deemed by their physician(s) to be suitable for warfarin; and

  • Have an appropriate rationale to seek a non-pharmacologic alternative to warfarin, taking into account the safety and effectiveness of the device compared with warfarin.

Despite the Watchman's inconspicuous size and relative ease of insertion with general anesthesia and, typically, one night of recovery in the hospital, it isn't appropriate for everyone.

For example, those who can take warfarin without incident or risk, Oral says, need a compelling reason to receive the implant.

"If a patient has a high risk of bleeding while on blood thinners, then it is a very good option," he notes, adding that general risks of taking such medication increases with age. In turn, that makes certain older patients suitable candidates.

Weaning off warfarin

Although one of the goals of implanting the Watchman is to help wean an individual off warfarin, the drug will remain a part of the patient's regimen for 45 days after the Watchman is inserted. After that, clinicians will use a transesophageal echocardiogram to determine if the implant has successfully closed the opening of the left atrial appendage.

"If all goes well, the patient is taken off of warfarin and put on a different type of blood thinner known as Plavix, along with aspirin, for another four and one-half months," says Oral. 

At that point, the patient stops taking Plavix and continues with an aspirin regimen. The Watchman, then, will keep watch on its own.

More Articles About: Health Tech Atrial Fibrillation Repair Cardiovascular: Treatment & Surgery
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories smart watch on wrist
Health Lab
Clinical smart watch finds success at identifying atrial fibrillation
A Michigan Medicine research team developed a prescription wristwatch that continuously monitors the wearer’s heart rhythm and uses a unique algorithm to detect atrial fibrillation. The clinical-grade device, called the Verily Study Watch, proved very accurate at identifying atrial fibrillation in participants.
heart organ yellow blue
Health Lab
Irregular heartbeat after valve surgery increases risk of stroke, death
Postoperative atrial fibrillation, commonly known as Afib, has traditionally been viewed as benign and limited. But a study led by researchers at the University of Michigan Health Frankel Cardiovascular Center finds that postoperative atrial fibrillation increases the risk of strokes and permanent Afib — and is linked to worse long term survival — after heart valve surgery.
Brain image highlighting areas
Health Lab
Women stroke survivors believe they will receive worse care in the emergency room
National study examined health care perceptions of approximately 3,500 women, including those with and without a history of stroke
surgeons in OR with blue and teal scrubs with screen on and patient under teal sheet
Health Lab
Treating heart valve disease: What are your options?
Michigan Medicine’s head of cardiac surgery, Gorav Ailawadi, M.D, M.B.A., answers questions about different treatment options for heart valve disease.
heart organ yellow blue
Health Lab
Older adults from distressed communities attend less cardiac rehab after heart procedures
Older adults who live in disadvantaged communities are less likely to attend cardiac rehabilitation after common heart procedures, a Michigan Medicine-led study finds.
heart image drawing
Health Lab
TAVR: Less than one-third of patients enter cardiac rehab after heart procedure
The vast majority of people who have a minimally invasive heart valve replacement procedure do not participate in recommended cardiac rehabilitation, a Michigan Medicine-led study finds.