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    LAAO Lets Many Patients Leave Blood Thinners Behind

    Chandrashekar Kumbar, MD, FACC, FHRS Deaconess Heart Group 02/01/2022
    For patients with atrial fibrillation (AFib), stroke is a serious risk. AFib affects the heart’s ability to pump blood normally. This can cause blood to collect in an area called the left atrial appendage (LAA), where a clot can form. 

    When a blood clot escapes the LAA and travels elsewhere in the body, it can obstruct the blood supply to the brain and cause a stroke.

    Medications, such blood thinners (or anticoagulants), are typically used as the first line of treatment. These medications work by thinning the blood to reduce the risk a clot could form that might lead to a stroke. This approach is effective, but can come with challenges and potential bleeding worries.

    Left Atrial Appendage Occlusion (LAAO) is a minimally invasive outpatient procedure used to prevent blood clots for patients with non-valvular atrial fibrillation who are unable to take long term anticoagulation. If you've been told that you have atrial fibrillation but have trouble with blood thinners, you may be a candidate for LAAO.

    In LAAO, a device is implanted to close off the small area of the heart (LAA) where clots are known to form. 

    There are currently two different devices with FDA approval for LAAO closure via catheter approach, WATCHMAN and Amulet. The type of device used is determined by the anatomy of the left atrial appendage and whether a patient can tolerate short term anticoagulation.

    Both types of device are placed via a catheter that is inserted into an incision (typically in the upper leg) and navigated through the blood vessels to the implant site within the heart's left atrial appendage. After the device is successfully implanted, the catheter is removed and the procedure is complete.

    This procedure typically takes 1-2 hours, and most patients are discharged the next day.

    A notable difference between the two devices is that, for several weeks after the insertion of the WATCHMAN, recipients temporarily take a blood thinner while the implant and the heart’s tissue work together, forming a seal against clots. With the Amulet device, patients do not typically need to take anticoagulants, although a patient's doctor may prescribe other medications based on the individual's specific situation.

    After an LAAO procedure, your doctor will provide guidelines for medications and activities, and will typically schedule follow-up appointments over the next year to make sure your recovery is going well. The physician will also report accordingly to Medicare and the American College of Cardiology registry.

    For many patients, LAAO provides permanent reduction of stroke risk that lets them leave blood thinner worries in the past.
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