How do you approach short term antithrombotic regimen, antiplatelets or anticoagulation, after Watchman device placement in ischemic stroke patients with atrial fibrillation and cerebral amyloid angiopathy who are at high risk for intracranial hemorrhage?

This is a good question. Our group published a paper on a series of patients with CAA who underwent placement of Watchman devices for atrial fib (Schrag et al., PMID 32770310). We usually did not anticoagulate patients at all, and we saw only one very minor stroke. I think that it would also be reas...

Antiplatelet monotherapy is sufficient unless we are dealing with Watchman device failure or device thrombosis with recurrent strokes. At that point, the discussion could be putting the patient back on anticoagulation as long as there is no prior lobar hemorrhage with CAA, and we are just dealing wi...