A 55-year-old woman with non-valvular atrial fibrillation (CHA₂DS₂-VASc score 4) refuses anticoagulation due to fear of bleeding. She asks about left atrial appendage occlusion (LAAO). Per ACC/AHA guidelines, LAAO with the Watchman device is indicated in:
- A All patients with AF and CHA₂DS₂-VASc ≥2 (women) as an alternative to OAC
- B Patients with AF who have an appropriate indication for anticoagulation AND have contraindications to long-term anticoagulation ✓
- C Patients with AF who refuse anticoagulation but have no bleeding history
- D Patients with valvular AF to avoid warfarin
Explanation
The FDA-approved indication for left atrial appendage occlusion (Watchman FLX) per ACC/AHA 2023 AF guidelines (Class IIb) is for patients with non-valvular AF who have a reasonable indication for OAC (CHA₂DS₂-VASc ≥2 in men, ≥3 in women) AND have a contraindication to long-term anticoagulation — such as high bleeding risk or history of serious bleeding. Patient refusal alone (without contraindication) is not a standard indication, and valvular AF (particularly rheumatic mitral stenosis) is a contraindication to Watchman. The PREVAIL and PROTECT-AF trials support its use.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.