Signed off!

I haven't posted on here for a while, simply because I've been AF free now for 14 months since the ablation. I saw my consultant for the last time this morning and we discussed the whole anticoagulation issue again. This was my final chance to come off them and with a CHADsVasc of 1 (being female), I don't really need them at the moment. However, I will need them in 6 years when I'm 65 and then I may or may not have to battle with my GP to take rivaroxaban (which I'm on now and which my EP asked them to put me on). I know that research will have moved on, but the bottom line is that I really don't want to take warfarin again. So for this and for other reasons, I've opted to stay on the anticoags long term. I really hope that i've made the right decision.

17 Replies

  • I think you have Sue. There is a body of opinion which thinks risk does not end with successful ablation. I only recently managed to get a score of 2 due to age but have been on warfarin for ten years now.

  • I was in the same boat as you a month or so ago. 13 months post ablation and AF free.

    In discussion and agreement of my EP we decided to stop taking Apixaban.

    My view is if you don't need them don't take them and the EP is the one who knows all the issues of your particular case.

    However, every individual will come their their own decision in consultation with their EP.

    Best wishes and really pleased that your ablation was a success.

  • Nice to hear from you. I agree with your reasoning and think that in your position I would do the same. Lucky you! I'm pleased to hear your ablation has been so successful and hope you'll be AF free long term.

  • Thanks Bob, Dave and Rellim for your replies. I shall stay with this site and comment occasionally if I think it will help others.

  • I'm so happy for you.Good idea to stay on the anticoagulant s as well. X

  • CONGRATULATIONS!!!! Great news. Re the decision, yes a case of a "hard decision" and there is no right answers as we are all different and the statistics blur these individual differences.

    I lean towards the "if you don't need it don't take it" view - but in your case there are a few unknowns. For example, the jury is out on the risks of stroke "post-ablation" -

    Assuming stroke risk remains the same post- as pre-ablation (a big assumption) then a score of 1 means you are on the cusp anyway ... so might make sense to err on the side of caution especially if you've been on anticoagulation for a while and feel stable. Another factor is that "coming off" anticoagulation could carry risks unless you are careful.

    The only other option is to look at the scientific evidence (or ask a scientist friend) and reduce your dosage to a level that still gives you reasonable protection, but carries less risk of problems from bleeding. This would be a more complicated route to take, and would need to be done in consultation with an EP who knows the literature.

    Anyway, congrats again - a successful outcome for you.

  • Thomps there really isn't a middle ground with anticoagulation especially NOAcs. They either work or the don't. With warfarin you get some protection from an INR of say 2 but some protection is not full protection obviously.

    The problem explained to me by a medic I trust is that ablation causes scars in the atrium and these scars, like deposits in a water pipe, can create eddies and those eddies can allow clots to form.

    Like many people I couldn't wait to get off warfarin post ablation (third successful one that is ) but once I understood that angle decided that it was like my marriage. For better for worse-- For life!

    You can always stop taking Anticoagulants but you can't undo a stroke.

    There is also a feeling amongst some specialists that un-recognised micro strokes may contribute to increased levels of dementia in AF patients. These are way below TIA level so would not be noticed. Can't quote chapter and verse but there was a paper a couple of years ago on this subject.


  • Thanks Bob, I was agreeing with the perspective of continuing anticoagulation, so we're in agreement :) Not sure what you mean by "no middle ground". Are you actually asserting that anticoagulation has an "all or nothing" effect on stroke risk, regardless of dosage, so there is "no middle ground" ... hmm, that doesn't sound right ... and re your comment "but you CAN'T UNDO A STROKE" - yes, true, but you know, I do worry about advocating decision making based on fear and anxiety. You also can't undo getting in a fatal air crash, or getting eaten by a shark, but that doesn't mean you shouldn't make rational decisions about your life based on a reasonable estimate of risk. In the end, I believe we are in agreement :)

  • Sorry if I wasn't clear but I was referring to NOACs. Agreed any choice should also include HASBLED to assess your risk of bleeding.

  • GOT IT! :)

  • Unfortunately, I saw both my parents debilitated by strokes - my father when he was only 61 and my mother much older. Whether they were AF related, I couldn't say and although strokes aren't hereditary, I've seen the devastation they cause. I've talked about this to my EP and he understands my reasoning behind sticking with the anticoags. I think we all agree that it's a blurry line, but if it was really not a good idea to stay on them, then I'm confident my EP would have said and insisted I stop taking them. As it was, he was happy with whatever decision I came to.

  • So sorry about your parents :(

  • Hope ablation works for me, as for the last 7 months I have had to lead a sedentory life, and it is really getting me down. After always being active. I am 67 and really hope this is not what the rest of my years holds for me. :(

    So pleased you are ok.

  • I wish you all the very best of luck, Annie. It certainly gave me my life back.

  • Thanks.

    I said to my cardiologist last week, I have lost 6 months of my life, and at my age that is rubbish, he is probably in his 40's, he said, I would hate to lose 6 months of my life even at my age, we will do the best we can. At least I have been referred to the hospital which has brand new revolutionary equipment, thankfully wont have to wait too long :)

  • I think you are right to do so Sue, 12 months post ablation I was taken off warfarin and out of the blue went into AF which caused a Heart Attack , I will never feel safe again without anti coagulation.

    As we all know AF is so unpredictable and can lure you into false hope just to bite you on the bum out of the blue.

    I will take anti coagulation for ever now.


  • Thank you for the support, Elaine. I hope your health is OK now.

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