Evidence to continue with anti-coagulation at least three months post ablation

[Thomps95]

Interesting news story. Although it might be reasonable for some to stop AC following an ablation, even those with very low risk for stroke should remain on AC for a minimum of three months post ablation, and perhaps more.

medscape.com/viewarticle/84...

[Roseyuk]

Yes I was told this also, I am 10 weeks post second Ablation,

Also had Tamponade this time.

I have not yet had a follow up, with my EP as yet, still waiting for an appointment !

But had a spell of A/F a couple of weeks after my second ablation, and was fortunate enough to have seen a excellent cardiologist whilst in hospital, and he told me more about my heart problems than any other cardiologist or EP ..

Saying that after the trauma my heart went through due to the Tamponade, I should see my EP , every month,, and certainly stay on my Warfarin and beta blocker until at least August..

I've tried every way I know to get an app as my EP wanted to see me after 8 weeks, post ablation... Even my GP has written, but this NHS in the UK,

Is pretty much crap.. These days..

[PeterWh]

Very interesting indeed.

My EP stressed to me at consultation 8 weeks before ablation and on the day after ablation that for the first three months after ablation high risk of stroke. He said that INR range must remain at 2.5 to 3.5 for at least that duration. Partly I suspect because my INR was fluctuating quite a bit.

The interesting thing in the article is:

"For those who stopped oral anticoagulation at any time during the initial 3-month period following the ablation procedure, the risk of stroke was EIGHTFOLD [my caps] greater (hazard ratio 8.06; P<0.05) when compared with patients who remained treated with oral anticoagulation during the same time period".

I was astounded that the article also said:

"just 60.5% of patients continued to take oral anticoagulants at 3 months and just 62.5% of patients considered high risk for stroke—those with a CHA2DS2-Vasc score >2—were on oral anticoagulant therapy at 90 days".

It was stressed to me by EP and GP the importance of anticoagulation" (I am 60).

and.....

"However, they should not assume that eliminating AF will also rid the patient of the risk for stroke".

[MarkS]

I noticed that article yesterday and was going to post today but you beat me to it!

Very interesting. I see warfarin and possibly the NOACs are preferred for the ablation itself and not heparin.

Also those with CHADS2VASC2 greater than one should continue with warfarin for at least 12 months and potentially longer after discussion with the EP. In the UK that probably means for life since there aren't the resources to check fully for silent AF. As it says, an ablation is for relief of symptoms, not to get off anti-coagulants.

Mark

[PeterWh in reply to MarkS]

Certainly my consultant EP would not do ablation on NOACs (I was on Apixaban and had to change over to Warfarin which took almost 4 months to stabilise and only did so after ablation!!!). I had to take warfarin the night before as usual. Then on ablation day checked my INR which was 2.1 so it was "topped" up with Heparin.

I agree that in reality anticoagulants for life.

[PeterWh]

For the benefit of future readers this is a link to another post that is relevant:

healthunlocked.com/afassoci...

[Hidden]

I'm 10 years post ablation and still on Warfarin.

[BobD Volunteer]

Many of us prefer to remain on anticoagulation for life. I did once think that having been "cured "of AF meant I was no longer at risk but it was explained to me some years ago that the risk remains. Apparently even the ablation itself causes changes to the inner surface of the atrium which can make clot formation possible.

Bob

[Jason1971]

I'm 3 month post ablation now, but don't see my EP for another 4 weeks. I'll be honest I wanted off warfarin ASAP when first prescribed it, but having had no issues taking it for over 6 months now if my EP suggests there is no need to continue with it I will have a discussion over the pro's and con's. The only con I can see at the moment is the cost to me (I am from Yorkshire). I have over 20 years before I get it free, but not taking it may not give me those 20 years