blood thinners and surgeries

Was told I would most likely be on blood thinners for life after afib and ablation. What does one do if needing surgery ??? How does one run the risk of going off their anticoagulant before surgery?? This seems to be quite the dilemma and scares me just thinking about it. Most surgeries require going off for several days before. Also what about emergency surgery? Then what??!!!!

46 Replies

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  • I had a surgery last summer and had to go off my Xarelto. I talked with my EP about it and said the risk of stroke for those 5 days is infinitesimally small. I restarted the day after without problem. In case of emergency, the newer anticoagulants have a very short half life so it only takes a few hours to get it out of your system and in most cases, unless you just swallowed the tablet and had a major accident, remembering it takes a while to prep a person, for surgery you should be fine.

  • G'day Eliza,

    I am on Warfarin and have been on it since Jan 2010. In September 2012 I had a CT Scan and had to come off it. Then in November 2015 I had a partial knee replacement - both times I had to come off Warfarin. No problems at all. Re emergency surgery, I subscribe to Medic Alert who have all my personal details. So if I am in a motoring accident I have this dog tag around my neck with a phone number, whoever finds me rings this No. and hey presto they get all my info. Tomorrow, 28th Feb I'll try and find my statistics for u.

    John

  • Thank you so much!

  • Carneuny...I like the idea of medic alert. Going online now!

  • I had a hernia opp in hereford. Came off warfarin for five days. Some confusion somewhere! Had a stroke one week later, After informing them of my recent history, Portsmouth hospital emergency asked: was I on a heperin bridge? I said no.

    I was put on one.

    After many discussions with NHS boards etc. I am still convinced I should have been on that bridge. So, I would check thourougly your options.

  • Fuzz flyer......5 days is a long time to be off. How are you doing now ?

  • I had a partial knee replacement on 6 Nov 2015 and was put on Fragmin which I understand is of the heparin family. No problems. Just as well, the knee was bad enough afterwards.

    John

  • You know what Eliza, there are a number of folk on this forum with AF who are not on anticoagulants at all - can you believe it? Now that's 'risk taking'.

    You'll be ok stopping for the odd day or two.

  • Eliza and Robert, I have been with A-Fib for the last 3 years.

    I never took any anticoagulants.

    The Reason is that I have an AVM ( Arteriovenous Malformation)

    My Problem is that I cannot have an Ablation.

    I don't know which Ablation can be done with out Anticoagulants.

    Can any one tell me which Ablation can be done.

    I have heard that the Mini Maze can be done,

    or the Thoracoscopic PVI with a BipolarRF.

    Can any one if I can have any of these two done.

    Thank you.

  • My EP said that he would do an ablation without me being on Warfarin. I refused it and my GP said that he had never had a patient not on warfarin have an ablation.

    I've gone back on Warfarin now to have an AV node ablation that he also said does not require being on warfarin but the Southampton University Hospital patient information leaflet on it says that you should be.

  • Seasider18

    Thank you for your reply.

    I know what you are talking about the AV Node, and permanent pace maker.

    That was even offered to me but my EP said,That is the last resort we go for when nothing can else can be done..

    I am not in that position, my position is what I said I cannot take anticoagulants. My A-Fib is not a persistent one nor frequent so far.That is why I asked about the Mini Maze and the Thoracoscopic PVI with a Bipolar RF. From information I have these can be done. I wish to have a reply from some onethat myth had this experience.

    Thank you

  • And for ones of my age group:-)

  • Even though you are not a candidate for ablation, can you not take anticoagulants?

  • There are some people for whom anticoagulants are not suitable, that is why a mini-maze may be offered instead or other procedures.

  • Eliza1

    I am not a candidate for anticoagulants.

    That is why the Mini Maze and the bipolar RF

  • Eliza

    No I can not take anticoagulants

  • How long ago were you told that. If it was years ago then go and see one of the eminent EPs (privately if you can afford it) to see what the parameters and options are today that can be applied to you. Things have changed quite a bit in the last few years.

  • Peter,

    I was told two weeks ago that I can have the Mini Maze or the Bipolar RF.

    The Professor I am in contact with told me that he will take full responsibility for the treatment.

    He told me that in writing not just words.

  • I don't know why anyone would take that risk........and thanks Robert e lee for the support!

  • Emergency surgery - antidote for Wafarin is VitK. Many of ther NOACs also have procedures that eliminate the risk of bleeding out in an emergency, in the very unlikely event that you would need emergency surgery, but as SRMGrandma says, the life of the new anticoagulants is very short lived - which is why you would take them twice a day.

    As one those risk takers mentioned above, who don't currently take anticoagulants because I no longer have AF, my dilemma is do I restart taking them in a few months time just because I will be 65? I have other conditions and take meds which already increases the risk of bruising and bleeding.

    My view is life is full of risks, none of us know what will happen next but if we hide away not living our lives fully because we are paralyzed by fear of what might happen then you may as well give up on life all together. Address your concerns, make a clear decision and banish those nagging worries and fears.

  • When I turned 65, I carried on (in blissful ignorance as I hadn't found this forum) for 18 months without being aniticoagulated. I had rampant AF at the time but I was fine.

  • I ignorance certainly can be bliss!

  • Life is for living and fear is probably a bigger killer and spoilsport than the disease itself.

  • I think I would fear having a stroke far more than dying

  • The stroke you would have to live with.

  • So true dreamer.......wise words.......thanks

  • Interesting comment from HRC last year was that many EPs are now doing ablation without stopping anticoagulant or going on heparin bridge. Life changes and procedure likewise. My first two ablation I just stopped warfarin for five days and my third they bridged with heparin.

    Dentists used to send you to hospital if you needed extraction and were on warfarin. Now they don't bother and just wade in there.

    I guess for surgery it depends on what and where. Vit K is NOT an instant fix either as it takes time to work but there is a special drug who's name escapes me which can be used IF the pharmacy at the hospital has it and the pharmacy is open (i e not the middle of the night.)

    I agree with CD above that a life without risks is impossible. Understand those risks and move on.

  • Tranexamic acid?

  • My EP wanted by INR at >2.0 for the ablation and it was only 1.8 on the morning so he 'packed me up' with an anticoagulant as he put it to get me in range.

  • When I had my ablation I was told to just miss 2 doses......night before and morning of.

  • My Ablation was January 7th. I had been taking Eliquis for about six months before this. My Doctor had me take my regular Eliquis dosage the day before the procedure, skip one dose on the morning of the procedure and then go right back on Eliquis that night and continue Eliquis twice a day. This was the dose I had been on before.

    He inserted the catheters in my right groin. Two insertion sites. I had a small amount of bleeding there the first day while I was still in the hospital. No bleeding after that.

    I have read, the reason they are starting to keep you on blood thinners during the Ablation is, there is a slightly higher risk of a stroke right after the Ablation. The blood thinners lower this risk. I was all for it myself.

    I have been in sinus rhythm with no episodes for the two months since the Ablation. However, I am still on Tikosyn twice a day. My Doctor wants me to continue the Tikosyn for 90 days after the Ablation. I will know when I come off of this whether the Ablation was a success or not. I feel great right now.

  • Oh please.....!!

    Just talk to your doctor or are you stuck in the middle of the Sahara !

  • Sahara

  • What is the chance of you having a clot form and cause a stroke in the short time involved? I imagine practically nil.

  • I just went to my post-ablation followup and was told it takes 24 to 48 hours of afib to create the dangerous clot. Also, with my CHAD score, I have 3% risk of bleed and 3.5% risk of stroke not on anticoagulant, statistically. I am not in afib but will remain on very low dose Eliquis now, as per his recommendation (2.5 mg 2x daily). Better than nothing, and I don't bruise. Should I have an attack of afib (I feel every stray ectopic), I will take more. That's my compromise and I'm happy with it. When I have knee replacement in about three weeks, I'll do what that surgeon requires and not think another moment about it!

  • Teach to learn...tell me...how often do you feel stray ectopics? I'm feeling them often.....like everyday. Will wait to see if need 2nd ablation......ugh.

  • Yes, every day, but diminishing as 2nd ablation heals. Still on feccainide, though, and not off until May, per doctor's orders, so won't know about success of this one until then. I do wake up frequently in a flutter, until I wake fully and move. That seems to be diminishing, as well (fingers crossed). Emotional episodes, however, override ablation AND flec, so that's the one to avoid when possible! I don't think they'd ablate for only ectopics anyway.

  • My scary cardiologist asks patients who refuse warfarin if they want to have a stroke or die and that it only takes a second for a fatal clot to form.

    The problem is those of us over 80 on anticoagulants have a greater risk of bleeds than younger patients.

  • Yes, and all sorts of other reasons for clot formation not related to afib. The afib clot forms because of a certain part of heart's anatomy where blood may "pool" when heart isn't in normal pumping action. At 80, it makes sense to be on anticoagulant if there are other health concerns, too. My husband is 82 and has none of the usual indicators the rest of us seem to be heir to. He doesn't even have a doctor, so certainly no anticoagulants! So individual!

  • L have been on warfarin for 46 years after heart sergery no problem the only thing that you have to do is to stop taking it for a few days before as l had to do to have a pacemaker fitted all the best Gordon

  • Why must a person who has had a successful ablation 17 months ago and has had no arrithymmias nor afib since his ablation still on eliquis 2x daily??

    I was always symptomatic and knew when I was in arrithmmia, and now I use Alivcor

    app in conjunction with my Iphone 6 which daily shows whether my heart is in afib or Normal ?? I am a 76 year old male in otherwise excellent condition. Good diest, walk briskly daily, and do 20 minutes to fitness once weekly.

  • Worthwhile clearing up some myths.

    Even if people are on warfarin there IS still a possibility that they can have a stroke or a clot form. This probably happened in my case. I had a legs scan in December because of varicose veins and radiologist picked up that there was an "historical" clot in one of the superficial veins near the surface which had blocked off that vein. Impossible to tell exactly when it happened. I am not sure how long it takes for them to be totally absorbed (if ever). I had previously had a scan at another hospital for same thing and same leg about 9 months earlier and nothing was picked up then. Did the first radiologist miss it or hadn't it happened by then? This is still being investigated but GP had said it could have been in that intervening time. GP said people on warfarin do get blood clots and strokes, although GP said it is not very common.

    The question of warfarin or no warfarin varies from CCG (aka Trust) to CCG, from hospital to hospital and from consultant to consultant. Sometimes all three categories are aligned with a common policy and sometimes not. Sometimes an EP will insist on the patient being on warfarin continuously (one NO stopping on the night before or the evening of the ablation) and / or a defined set of parameters when doing it privately but at the NHS hospital the not stopping or the stopping and / or the parameters may be different. The key thing is to ASK.

    The actual INR range will vary as well. Sometimes 2.0 to 3.0 and other times 2.5 to 3.5. This was confirmed to me by both EP and local Anticoagulation service covering four hospitals. In my case EP certainly wanted 2.5 to 3.5 and I am not sure whether that was because of the ablation itself or because he was almost certain that I would need a cardioversion after to restart heart in sinus rthythm or because he knows that after an ablation there is a natural dip in INR. In the event on the day it was only 2.2 so he gave a boost or bridge but even then by four days later it had dropped to 1.7 or 1.8 so extra warfarin taken to get it back up. I also had a TOE before they started my ablation.

    Re NOACs. For my original cardioversion 4 months before ablation I remained on Apixaban. I have even heard that some people have remained on a NOAC for an ablation but I don't know whether this was part of a trial or whether there is sufficient confidence around NOACs coming in or because people were having real trouble with warfarin. I seem to recall this also being mentioned at last year's patients day but I am not sure on this. Also some consultants won't do a cardioversion unless people are on warfarin (rather than a NOAC).

    With many medical aspects, but particularly with respect to things like AF and flutters, contrary to what most people think, many decisions and thoughts are an art, based on knowledge, patient circumstances, risk assessments, consultants personal beliefs, hospital's policies, etc, etc rather than a science. Patient's preferences may also affect final decisions.

    It was the revised NICE guidelines that has stopped dentists insisting that people stop taking Anticoagulation for a number of days (had been up to 7 for some) before any dentistry even if it didn't involve an extraction. An INR level of 4.0 would not have been set if there were real and significant risks!!!!!

    Some minor procedures / operations are nowadays carried out without stopping Anticoagulation. This is based on a risk assessment. As one consultant said to me the risk of a stroke was much higher than the risk of severe bleeding when things like moles, etc were being removed. I have not experienced this situation personally.

  • I forgot to include with AF, as with nearly every area in life, there are risks. Sometimes the risks in life may be extremely small but at other times quite significant but then it still can be a risk worth taking. For instance, this was the case for quite a nummer of people in the early days of organ transplants.

  • People who are normally symptomatic can have AF episodes that are asymptomatic (either in the daytime or at night time).

    There are many aspects relating to AF that the whys and wherefores are just not known but are hypothesis.

  • As you say advice varies from doctor to doctor and area to area, my EP preferred to have me on NOAC, I hadn't been on any anticoags beforehand, because then he could ablate within 2 weeks - that was 2013. I took my last dose 12 hours prior to ablation and next 8 hours following.

    His preference was NOACs over Wafarin every time. He had participated in the first trials on NOACs so that is maybe why? He certainly had confidence in them but said they were not for everyone.

    Judging risk is an art, but also involves judgment and a reasonable grasp of statistics, like any skill one hopes that the more one practices the better one becomes.

    There are no black/white answers here, just a sea of various shades of grey.

  • I think it's definitely down to cost! My AF began in Tenerife whilst on holiday,due to Septicemia!

    On discharge after nine days in hospital both the EP and Cardiologist recommended NOAC`s! They said if our NHS could afford it,it was recommend by most European Specialists!

    I was given Apixaban and my English Cardiologist was surprised my GP agreed to carry it on!

    He said he kept recommending it for patients,but kept having discussions as to why not Warfarin!

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