WATCHMAN patient

See Which of Your NVAF Patients Can Benefit from WATCHMAN

Appropriate patients may have one or more of the following:

  • A history of major bleeding while taking therapeutic anticoagulation therapy 
  • Prior inability to maintain a stable therapeutic International Normalized Ratio (INR) or to comply with regular INR monitoring AND unavailability of an approved alternative anticoagulation agent 
  • A medical condition, occupation, or lifestyle placing the patient at high risk of major bleeding due to trauma

Some examples of appropriate rationales to seek an alternative

  1. History of bleeding
  2. Increased bleeding risk based on HAS-BLED score or other factors (e.g. thrombocytopenia, cancer, or risk of tumor associated bleeding in case of systemic anticoagulation)
  3. History or risk of falls
  4. Documented poor compliance with OAC therapy
  5. Inability or difficulty maintaining therapeautic range
  6. Occupation that puts patient at an increased bleeding risk
  7. Severe renal failure - medical condition for which OAC inappropriate
  8. Avoidance of triple therapy after PCI or TAVR
  9. Other situations for which OAC is inappropriate
  10. Unable to obtain information
  11. Drug or medication regimen not compatible with oral anticoagulant therapy

Frank, 80, high risk for bleeding

Occupation: Involved grandfather
Medical conditions: NVAF, congestive heart failure, hypertension, diabetes
CHA2DS2-VASc score: 5

Frank is suitable for warfarin, but he is currently taking 15 mg of rivaroxaban daily. He has a history of falls, resulting in a broken hip and cerebral contusion. His physician believes his medical conditions place him at a high risk of major bleeding secondary to trauma.

What approach do you take with your NVAF patients at high risk for bleeding?

Catherine, 68, struggles with compliance

Occupation: Retired, volunteer
Medical conditions: NVAF, hypertension, vascular disease
CHA2DS2-VASc score: 4

Catherine takes 5 mg of warfarin but is unable to comply with regular INR monitoring because she lives far from the clinic and cannot afford novel oral anticoagulants (NOACs).

What approach do you take with your NVAF patients who struggle with compliance?

Abigail, 72, leads an active life

Occupation: Retired, frequent flyer
Medical conditions: NVAF, hypertension
CHA2DS2-VASc score: 4

Abigail is currently taking 5 mg of warfarin, but her physician feels that her active lifestyle and frequent travel place her at high risk of bleeding should trauma occur.

What approach do you take with your NVAF patients with active lives?