With atrial fibrillation, the heart may not be able to pump blood normally. This can cause blood to pool in a small pouch that sits off the left side of the heart, known as the left atrial appendage (LAA), and form a clot. If left untreated, the clot can enter the bloodstream, travel to the brain and cause a stroke.

To reduce the risk of stroke, physicians often prescribe a blood-thinning medication, or anticoagulant. These medications slow down or prevent blood cells from clumping together to form a clot. But they may not be appropriate for everyone.

“Despite their effectiveness, taking blood thinners may be difficult for some patients,” says Dr. Sheldon Singh, a cardiac electrophysiologist at Sunnybrook’s Schulich Heart Centre. “These medications are not always well-tolerated and they present a risk for bleeding complications.”

How a unique heart device can help prevent stroke

A treatment called the Watchman implant is an alternative to blood thinners. It is designed to permanently seal off the appendage in the heart where blood clots can form.

“This procedure can protect those who are at a high risk of stroke from atrial fibrillation but who either cannot take blood thinners, or cannot take them consistently for a long period of time,” says Dr. Singh. “Studies have shown that, on average, people who got the implant lived longer than those on some blood thinners, likely caused by life-threatening bleeding.”

In the minimally-invasive procedure, a specialized device is guided by a catheter through a vein in the upper leg and into the left side of the heart. Once in position, the implant is released and seals off the left atrial appendage. Over time, heart tissue grows over the device to create a permanent barrier. The procedure typically takes an hour, with only a 24-hour recovery time.

More procedures, more lives

In the five years since Sunnybrook first introduced the minimally invasive treatment, approximately 40 patients have received the device, with the help of donor support.

During that time, a new iteration of the device first used in Ontario by Sunnybrook has made it easier to implant, says Dr. Singh, “which makes the procedure quicker and safer.”

In March 2020, the Ministry of Health announced its decision to fund 20 Watchman cases annually at Sunnybrook, along with five other centres in Ontario, making the life-saving procedure more accessible for patients who need it. After completing all 20 cases within just five months, the Schulich Heart Centre will be resuming the treatment in April 2021.

“With provincial funding and growing capacity, the procedure is gradually becoming a valuable and more commonly accepted alternative,” says Dr. Singh. “This means we have more opportunities to reduce the risk of stroke in people with atrial fibrillation who previously had very few options.”

Global studies are underway

The Schulich Heart Program was recently selected as one of three Canadian centres, and the only Ontario program, to participate in a clinical trial evaluating the Watchman technology. It is also one of only two Canadian centres chosen to participate in a pivotal global trial evaluating the Watchman against blood thinners in the general population with atrial fibrillation. Set to launch in 2021, the U.S.-run trial will involve patients who have received ablation to treat atrial fibrillation. Researchers will compare the outcomes of those who take blood thinners to those who receive the Watchman device.

“If you have atrial fibrillation and you’re looking for an alternative to blood thinners, speak to your cardiologist about your options,” says Dr. Singh.

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Are you on blood thinners? Do you see red?

Many people on blood thinner medications will experience visible blood in the urine that is severe enough to require medical attention, a new study published in JAMA has found.

What are blood thinners? Antithrombotics – also called blood thinners – include anticoagulants and antiplatelets.

Blood thinners are often prescribed to people with heart disease, or those who are at risk of blood clots or stroke.

Antiplatelet drugs, such as aspirin, prevent blood cells called platelets from joining together to form a clot.

Anticoagulants, such as warfarin, lengthen the time it takes to form a blood clot.

2.5 Million: The study looked at the data of 2.5 million Ontarians over a 13-year study period. 800,000 people were prescribed antithrombotic medication during the study period. For those who had been on blood thinners, 123 per 1000 people had visible blood in their urine. The bleeding was severe enough to require medical intervention like a procedure, ER visit or hospital stay.

Older men are more at risk of severe bleeding requiring a trip to the emergency room.

Unmasking a silent cancer: The study also showed blood thinners unmasked the presence of silent bladder cancer (due to the bleeding) at a rate that was more than twice that of the general population.

What does this mean?

• Blood in your urine can cause distress and further complications, like infections and kidney failure.
• If you have blood in your urine, don’t delay. Talk to your doctor.
• Talking about this with your doctor can help reduce the risk of requiring medical intervention or a hospital stay.

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Find out more.

Read the full study.

Bladder Cancer Canada.

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