I'm sure this has been asked hundreds of times before, but I was just wondering about the anticoagulants after ablation

I have had exercise induced PAF for 18 months and with a CHADVASC score of 0, wasn't given warfarin. Once we decided to do an ablation, I went on warfarin and will be on it at least until 5-6 months post ablation. My EP/cardiologist says that when I go back to see him 5 months post ablation, if everything is well, he'll think about taking me off the warfarin. My thoughts are: if I no longer have AF, then there's no reason to stay on warfarin, but it seems that lots of you remain on warfarin post ablation and I'm wondering whether I should too.

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  • It is very controversial on this site! I will be going off Xarelto once we see there is no more AF. Mine is very clear, I know quite well when I am in AF or not, so I am not worried about going off the anticoagulant. You will hear many more opinions before the day is over! Which is a good thing. Take care

  • Thanks Iris. Despite dreading going onto warfarin, it's kind of like a comfort blanket now - silly to take if it's not needed though. I have the utmost respect for my Doc, so whatever he says, I'll do.

  • OK so lets be logical here. If you really do have a Chasdvasc score of 0 then you shouldn't need anticoagulant. BUT it is important to remember that scores once given can not be discarded, so for example if you are on blood pressure medication even though you have normal BP your score is one there. Not having AF does not remove the risk either I was told. So as a further example if you are female taking BP meds then your real score is 2 and if you are of a certain age then could be 3.

    In the end , a lot of this is about patient choice and the new patient aid from NICE gives clear risks of both stroke and bleeding scores to enable patients to decide what they want to do. Agreed many of us on here decide that they wish to continue on warfarin or NOACs because we fear stroke more than bleeds but it is up to you to make that choice. .It has been said many times that you can always stop taking warfarin but you can't undo a stroke and if you have stable INR and do not suffer any major side affects of the stuff then it could be a difficult call to make.

    There now that wasn't too controversial .was it?

    Bob

  • Always good advice Bob, no controversy only choices!

  • Thanks Bob. My score really is zero - no BP meds - in fact I've never been on anything at all except the warfarin for the ablation. To be honest, if I hadn't have joined this site, it would have never crossed my mind to stay on anticoags beyond the 5-6 months or so. Its just that so many people seem to be on them in spite of a successful ablation. But I trust my EP/cardiologist to make the right decision for me so watch this space.

  • If you are female your score will be one regardless. Sex discrimination. Lol

  • My case

    Had AF then cardioversion and back into in sinus so put on aspirin as a precaution.

    However I went into permanent AF with no symptoms for god knows how long as puse take at BP clinic revealed AF back!

    So by following old guidelines I was in danger for some time.

    I don't see it as a difficult call anti coag rules ok

    Eddie

  • My score is also zero. I went on warfarin before my ablation and was told I needed to stay on it for three months afterwards. When I queried this I was told that the ablation creates scar tissue which can cause blood clots to form but that the scar tissue settles over time. Because my score is zero and also because I spend a lot of time in places where medical assistance is not readily available I will be coming off warfarin after the three months are up. As I age or another medical condition pushes my score up I would not hesitate to go back on it.

  • Thanks kakapo. That's more or less my thinking. I'll come off the warfarin if advised but wouldn't hesitate to go back on if necessary. I wish you a good recovery and an AF free future.

  • The usual process is that if you didn't need to be on anticoags before, then you'll go on for the ablation and come off 3-6 months later. If you did have to be on anticoags before (e.g. CHADsVASC2 >= 1) then you'l remain on them afterwards.

    There is no definitive evidence so say you can come off if you have a successful ablation. However Prof Schilling did ask me after my ablation to write to him periodically to see if that is still the advice and I haven't done that yet. More urgent tasks keep getting in the way but I really must!

    Mark

  • Choose wisely Sue, you may only get one shot at this. Ablation is not a cure for AF. Aspirin is not an anti-coagulant. You have AF (there is no known cure in 2014) and, if you are not properly protected with an anticoagulant, you are at least 5x more likely to have a stroke than your similarly profiled neighbour who doesn't have the condition. And that statistic applies to you whether you are in an AF episode or between them..........you have AF, that's the key point.

    Yet, according to CHADS, If you have a score of 0 or 1 then you don't need an anticoagulant. Now there lies the controversy - a very dangerous controversy. Let's look at at a simple fact: Every 15 seconds someone suffers an AF-related stroke accounting for nearly 20% of all UK strokes. "AF is the most powerful single risk factor for suffering a deadly or debilitating stroke" (AFA) and sadly "nearly 70% of those that are AF related are fatal" (AFA).

    Because the high CHAD scorers will have been properly protected, the large majority of those AF related stroke victims are either the undiagnosed or low scorers who wrongly believe they are safe without anti-coagulants. Paradoxically therefore, the lower your CHAD score - the greater your risk of stroke. It's a funny old world isn't it? So full of unintended consequences......

    There is the much smaller risk of bleeds with anticoagulants of course - though you would normally make a full and lasting recovery should you be unlucky enough to experience one of those. And there are a small number of folk who just can't take take them due to adverse side effects. But most of us can..... and should.

    It's a 'no-brainer' Sue, but of course....it's your choice. But really, why wouldn't you ....Anticoagulate Now?

  • Well at least I don't have to make a decision until October, so I think I'll stop worrying about it until then.

  • You're making a decision now Sue - to do nothing for 4 months......

  • My E.P. has told me I can not come off warfarin as even after ablation I will be at risk of stroke. I have no other conditions and am correct weight blood pressure Tec. But have had 3 TIA s so that gives me a score of 3 .I don't mind except on days like today when unexpectedly my I.N.R. is 4. Oh well at least I can eat some broccoli!! X

  • Am I right in assuming, Dedeottie, that you have self tested and are not adjusting your dose but controlling your INR with eating high Vit K foods?

  • Yes initially that is what I have done but because it is quite high if it is not on its way down by tomorrow I will reduce my dose slightly and if it's still not going down I will ring the warfarin clinic for advice but I am expecting it to be ok again before then. X

  • Thanks. Interesting. Are you able then to gauge the sort of vitamin K intake that will drop INR a point or two?

    I ask because it is becoming clear to me that I shall have to bite the bullet and come to terms with the fact that I will have to stay on warfarin (which, just in case you hadn't noticed, I absolutely loathe) and must buy a self check gadget and strips. I think my GP will provide some, but I'd like to keep an eye on the INR as I think the surgery are a bit casual and I'm forever dropping below 2.

  • That is exactly why I have one as well. To try and answer your questions:

    As you have probably guessed by now warfarin v vitimin k is not an exact science because for one thing, everyone's tolerance of both seem to differ widely. However you do get to know your own bodies reactions over time so while I wouldn't know exact amounts I do have some idea of what will help the situation in my case. what it means for me is that I avoid some of the knee jerk reactions I was getting from my warfarin nurse. If my I.N.R. was too high My dose was lowered but then there was no check on what happened over the next few weeks so my readings could be low until the next time I had an appointment. With the machine I feel back in control which is important for me. Hope this helps a bit. X

  • Thanks for that. I've only once had an INR over 3. Well twice but both in the same week, tested in different places. My trouble is the reverse and I struggle to get up to 2 most of the time, and had to give up eating anything with vitamin K in to get four consecutive weeks over 2. They seem reluctant to up the dose very much. I've now had 30 INR tests in less than a year, so self monitoring would save a lot of time and effort.

  • I was on warfarin for 8 weeks before my second ablation (hadn't been on them before or after my first) and was kept on them for 4 weeks after my ablation. However, I was kept on daily aspirin but came off it as it was not helping my chronic gastritis. Like Iris, I would know when I am in AF so am not worried about not being on anything at the moment.

  • Hi AnticoagulateNow - when I said I won't worry about it for 4 months, I meant the decision to stay or come off won't be relevant until then. Right now I'm anticoagulated up to my eye balls! I do wish that my surgery would consider the new anticoags though. I would like not to have to watch what I eat and drink.

  • Rellim296. Interesting you say that your surgery is a bit casual. I had my INR done this morning and it was 2.1, so in range - just however, it's dropped from 2.5 two weeks ago to 2.1 even though the dose had increased slightly (only by 1mg over a week but from past experience, this dose wasn't sufficient to keep in range). I asked if we could add another 1mg over the week (which before ablation, would have held the levels at around 2.5), but I was told no. I told her I'd had a couple of salads (made with iceberg lettuce though so not the high vit K stuff and not really any more than usual). She just said don't eat the salad. I'm a bit fed up about it actually.

  • I understood that vitamin K should fit around you, not you having to alter your diet and the advice seems contrary to that and I would be peeved at such a suggestion too. Personally I don't think an INR of 2.1 is good enough, even though it is in range. Even though suggesting anything to the nurse does not seem to go down well, I'm sure I would have asked for an increase as you did. How long before your next test?

  • Therealsue I think you sound as if you are getting to the point where you know what is needed to keep you in range!!

  • Hi Rellim296 - three weeks to the next test!

  • Well, lots of choice! You can stick to no salads and tread carefully, you can demand a test sooner, you could just quietly take more warfarin and tell them - I wouldn't dare do this as it would lead, I imagine, to all sorts of fireworks - or take it and not tell them. I'm not suggesting you do this either, just thinking it is one of the possibilities. Or do what I did last time I had an INR of 2.1 - just take the pills exactly as directed and return when summoned. INR was 1.8, of course. When I mentioned this to my GP he seemed to think that an INR below 2 wasn't too bad at all, and would provide some protection. Given that I am convinced (perhaps wrongly) I'm likely to be a bleeder, I'd rather have a low INR than a high one.

  • Hi Rellim296. I think I'll leave things as they are despite the temptation to sneak an extra pill. I take and always have, fish oils, so I'm hoping that it'll all help and if I'm out of range in three weeks time, I will think (although I won't say!) 'I told you this would happen'!!

  • Yes, that's what I opted for - and I said nothing too! I am currently not seeing the surgery's INR expert with whom I spent 6 months but the delightful lady who tells me she just sees with the run-of-the-mill patients. She does what the computer tells her.

    Yes, I used to take fish oils and perhaps should do so again. I currently take a hair, nails and skin multi vitamin.

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