Getting off blood thinners for good

Sal was on a regimen of pills for his heart conditions, but blood thinners were the worst. Now that he's had The Watchman device implanted for his AFib, he can stop worrying about those risks.
July 10th, 2020
Sal sitting on his front porch with his yankee's jersey and hat on, a few weeks before getting off blood thinners entirely..
Sal Delprete is a Yankee fan. His cardiologist is a Rockies fan. But the two agreed wholeheartedly that getting off blood thinners would be a great option for Sal. Photos by Kati Blocker, UCHealth.

Sal Delprete is a Yankees fan through and through. His childhood was filled with 75-cent visits to Yankee games, and in his father’s last year of life, the family attended all 81 home games from box seats — his father’s dying wish.

Everything Sal knew of baseball, he learned from his father.

At 13, Sal caught a ball from one of baseball’s most feared hitters, Mickey Mantle, which Mantle then signed. And now, even as a Colorado resident, Sal’s devotion to his hometown team is immutable.

Dr. Matthew Purvis at a Colorado Rockies game
UCHealth interventional cardiologist Dr. Matthew Purvis and fourth-generation Coloradan enjoying a day at Coors Field. Photo courtesy of Matthew Purvis.

One of Sal’s favorite doctors, UCHealth interventional cardiologist Dr. Matthew Purvis, is fully aware of Sal’s East Coast allegiance. The two banter about baseball during appointments or when they pass in the hallways at UCHealth’s northern Colorado facilities, where both work.

Purvis is a fourth-generation Coloradan, so not surprisingly, he’s loyal to his hometown team, the Colorado Rockies. These men love to rib each other about which baseball team is better; it’s all in good fun.

But, they actually agreed wholeheartedly on a life and death matter. Sal could benefit mentally and physically from a medical device, and the expert cardiology team at UCHealth were the perfect providers to implant it.

Sal, 71, works the overnight shift cleaning as an environmental services (EVS) technician at UCHealth Harmony Emergency Room in Fort Collins. He’s worked for the local health care system since 2012, starting at UCHealth Poudre Valley Hospital. But the past few months have been more daunting than ever as the novel coronavirus swept the state. Despite worries about the dangerous virus, Sal has manned his post and kept rooms clean for patients. He managed to do all of this even though he was facing his own health challenges.

Getting off blood thinners

For years, Sal has been on blood thinners because he suffers from atrial fibrillation (AFib), a type of heart arrhythmia. In January of this year, just before the pandemic hit Colorado hard, UCHealth interventional cardiologist Dr. Justin Strote placed a medical device known as “The Watchman” in Sal’s heart via a catheter through an artery in his leg. The device closes off the left atrial appendage, eliminating the risk that a blood clot might escape into Sal’s arteries and cause a stroke. The surgery also has enabled Sal to soon stop taking blood thinners.

He’ll no longer have to worry about an accident that could send him to the hospital to check on any internal bleeding. Nor will he have to fear the nosebleeds and bruising that also came with the blood thinners. Freed up from these health worries, Sal can instead focus on the biggest part of his life right now: keeping his team and UCHealth patients safe from COVID-19.

Sal standing in ER room as a EVS technician.
When everyone else is sleeping, Sal Delprete is working the night shift at UCHealth Harmony Emergency Room keeping patients and staff safe from infectious diseases.

“EVS is the first line of defense against cross-contamination of hospital-acquired infections. What they do is important for patient outcomes as well as the safety of patients and staff,” said Dutch Fla Havhan, Sal’s manager. “I know when Sal’s working that I’ve got one less area I have to worry about because I know the job will be done properly and effectively.”

What is AFib?

AFib affects over 5 million adults in the United States, and one in three will suffer a stroke. This is because AFib can decrease the heart’s pumping efficiency by as much as 30%. This poor pumping increases the risk of clots forming in the heart chambers, especially the left atrial appendage, a small pouch in the heart’s left upper chamber. If one of these clots breaks off and travels to the brain, it can cause a stroke.

People with AFib are often given Warfarin, a blood thinner. This helps prevent clots from forming, but it comes with dangers too. Blood thinners mean more risks associated with bruising and bleeding. As with Sal, a bump on the head or a nose bleed can become life-threatening.

“If you have AFib, you need to be on a blood thinner to prevent strokes,” Purvis said. “But it is a double-edged sword. It’s helpful for one thing but provokes other problems such as nose bleeds or bloody urine. The risk of a stroke outweighs a nose bleed, but with this newer technology, there is this option to get off Warfarin.”

Lifestyle affects heart issues

Although family history is a large factor in heart disease, Sal is the only one in his family to have struggled with hypertension, cardiomyopathy (weakness of the heart muscles), and AFib.

His high blood pressure first started after he enlisted in the Navy in 1969, so he wonders if stress had something to do with it. Although the stress never subsided as he aged, he was able to manage his hypertension with medication.

Sal in his Yankee hat and jersey
Sal Delprete.

After serving in the military, Sal spent 20 years as a customer service specialist for the United States Postal Service. He worked 14-hour days as the “troubleshooter,” handling complaints, standing up for workers and straightening out issues.

Meanwhile, his first wife, Margaret, fought cancer — seven times in total, including three different occurrences of breast cancer. Her medications were expensive, so Sal skipped buying necessary blood pressure medications. The couple moved to Colorado after Sal retired in 2007. It was then that he started seeing Purvis.

“At that time, Sal had cardiomyopathy but no blockages so we put him on medication to treat and improve his AFib,” Purvis said.

Sadly, Sal lost his wife to cancer in 2010.

He spent a lot of time at Poudre Valley Hospital while Margaret was getting treatments. And he’d see Purvis in passing, stopping for some baseball banter that would lighten every visit. Sal later applied for a laundry position at the hospital and later joined the EVS team. And in 2011, he married Debbie.

Managing your health alongside the cardiac experts

“Sal is a guy who never complains,” Purvis said. “After years and years of taking care of him, I can see it when he’s doing well, and when he isn’t.”

In 2017, echocardiography showed Sal’s heart was weakening, prompting a coronary angiogram, which showed a significant blockage in the main coronary artery that supplies the heart muscle with blood. Purvis placed a stent within the artery to open the blockage. It worked, but it added a daily, lifelong dose of Aspirin to his regimen of pills, as well as another blood thinner, Plavix, for the next year.

And though there were few alternatives beyond medication for many of Sal’s heart issues, he did have an option that could help him get off the needed blood thinner for his AFib.

“Over the past few years, Sal talked about wanting to come off the Warfarin because of the hassle of the bleeding and bruising,” Purvis said.

The bruising seems to have gotten worse over the years, Sal added.

“I would get black and blue bad. It looked like someone beat the heck out of me,” Sal said. “I had a habit of bonking into things. It relaxes your mind realizing you’ll get off blood thinners.”

Sal and Purvis both agreed that he was a good candidate for The Watchman, which the U.S. Food and Drug Administration approved in March of 2015. UCHealth performs over 100 Watchman procedures annually in northern Colorado.

Sal putting a pillow on an ER bed.
Sal Delprete puts the final touches on an emergency room he just cleaned and disinfected. Sal is soon getting off blood thinners and won’t have to worry about the risks that come with taking them.

Returning to life

After The Watchman is implanted, patients stay on blood thinners for a period of time — usually 45 days — while the heart muscles heal around the device and close off the area where clots might escape. Sal was able to cut out one AFib medication in February after Purvis confirmed recently that his heart has properly sealed around the new device. In the next month, Sal should be cleared to get off his other blood thinner. He will continue daily aspirin doses because of his stent, Purvis said.

Remarkably, Sal returned to work only a week after his implant and he’s kept going through the biggest challenge of his career.

A normal baseball season would have provided some much-needed pleasure this year. Even a shorter season would bring Sal great joy.

“I’ve been champing at the bit for this one,” he said.

Meanwhile, as the rest of us sleep, Sal spends his night shifts making sure the emergency room, pharmacy and laboratory sparkles.

“My heart is getting stronger,” he said. “And at my age, working is also keeping me strong. To think, I’m 71 years old, and me working nights, people tell me I’m crazy. But it keeps me going.”

And Purvis said that The Watchman also helps Sal keep going.

“Hopefully, I’ll get to follow Sal for another 30 years,” he said.

That would add up to a lot of baseball banter.

 

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About the author

Kati Blocker has always been driven to learn and explore the world around her. And every day, as a writer for UCHealth, Kati meets inspiring people, learns about life-saving technology, and gets to know the amazing people who are saving lives each day. Even better, she gets to share their stories with the world.

As a journalism major at the University of Wyoming, Kati wrote for her college newspaper. She also studied abroad in Swansea, Wales, while simultaneously writing for a Colorado metaphysical newspaper.

After college, Kati was a reporter for the Montrose Daily Press and the Telluride Watch, covering education and health care in rural Colorado, as well as city news and business.

When she's not writing, Kati is creating her own stories with her husband Joel and their two young children.