ELiquis for life???

[Salty0987]

I've had 2 abalations and have been on Eliquis since last Oct. I had a 24/7 monitor on for a week and went to see the EP for results last week. Saw the nurse practioner and I was in NSR 97% of the time but she told me I would be on Eliquis for LIFE. I thought this was just a temporary drug. What are others opinion on taking it for life? She said they have discovered that people who have had abalations need to do this.

[Dodie117]

I am also on this. I think you will find that most of us on here are on this or another anticoagulant and expect to be on it for life. It is our protection against stroke so I for one am very pleased to be on it. I also had an ablation but this is not a cure so generally we are advised to stay on anticoagulant.

[Salty0987 in reply to Dodie117]

Thank you!!!!

[Thomps95]

Yes ablation reduces stroke risk, but some prefer to remain on anticoagulation simply for peace of mind; others are indicated for anticoagulation because they have lots of other risk factors for stroke.

Here is one study showing that once you have an ablation, your long-term risk of stroke is identical to people without atrial fibrillation in the first place.

heartrhythmjournal.com/arti...

One problem is that most people who have an ablation have many risk factors for stroke. These various stroke risks tend to mask or diminish any stroke reduction resulting from the ablation. As one study concluded: "Patients with high CHADS2 score, history of TIA/stroke, cardiomyopathy and postprocedural AF undergoing successful ablation of typical AFL remain at an elevated and continued risk for stroke after AFL ablation." Well, obviously!

content.onlinejacc.org/arti....

In other words, if you already have lots of risk factors for stroke to begin with, and you have a successful ablation, that's going to help a bit but it is not going to address ALL your risk factors, so you should probably remain anti-coagulated.

What about if you have no stroke risk factors other than AF? The first reference above suggests your stroke risk will be very low post ablation - the same as healthy adults without AF. However, there are two caveats. First, given you were already taking anticoagulants, you clearly do have other risk factors (unless you went on anticoagulation against guidelines given your CHAD2VAS2 score). A second caveat is that we know stroke risk is elevated for the first few months post-ablation, so everyone undergoing ablation should be anti-coagulated at least for a few months, even if one's CHAD2VAS2 score is below the threshold value for anticoagulation (but again, I assume you do have other stroke risks. Otherwise, why would you be taking anticoagulation?)

medscape.com/viewarticle/84...

Hope this helps!

[Salty0987 in reply to Thomps95]

Thank you...my EP wouldn't abalation me without being on Eliquois but I am an overweight woman with high blood pressure and 69 years old so that has put me at higher risk. Thank you so much for your reply.

[Thomps95 in reply to Salty0987]

Sounds like you are in good hands should definitely remain on anticoagulation. Luckily, it is an easy tablet to take so not an inconvenience. Best wishes for continued health!

[beardy_chris]

I'd rather take Eliquis for life than risk having a stroke - which would also be for the, possibly short, remainder of my life.

[BobD Volunteer]

It is generally accepted by most experts that ablation does not remove any stroke risk. In fact the scar tissue generated may actually promote eddying of blood which could allow clots to form. It is for this reason that most of us choose to remain on anticoagulation for life . It is of course up to each individual to make their life choices. You can always stop taking anticoagulants but you can't undo a stroke.

The other point to make is that with AF, the amount of time or number of times one may be in arrhythmia is not relevant to stroke risk.

[Salty0987 in reply to BobD]

BOb, that is interesting to me because of all my googling😀 I have never thought of the stroke risks involved when I am in NSR. I just assumed that if I was in NSR a stroke wouldn't happen but with all the abalation scar tissue that makes perfect sense. Thank you for that light bulb moment.

[BobD Volunteer in reply to Salty0987]

I too made the assumption many years ago that since my ablation had been successful then I didn't need anticoagulation but fortunately due to my involvement with AF Association I have met a great number of leading experts who disabused me of that view. Maybe when I get much older and perhaps my HADSBLED score may exceed my ChadsVasc I might have to review this.

Bob

[PeterWh in reply to BobD]

Some reckon even when hasbled is greater it's not a straight forward thing because the the two scales are not 100% comparable nor 100% accurate and also the medic and patient need to take all the risk factors, severity, likelihood, history (own and family) and a number of other factors before deciding. Also the patient's own thoughts and attitude.

[Salty0987 in reply to PeterWh]

Thank you Peter

[traveler65 in reply to BobD]

@BobD I appreciate this info. I did not know about the scar tissue and eddying issue. BTW, are their other types of ablations besides radio frequency, such as cryoablation, which do not leave a scar? do you know if cryo leaves scar tissue? I've already had the rf ablation and I am fine with the rx's etc, but just curious.

[BobD Volunteer in reply to traveler65]

if it didn't scar it would not be an ablation. The scar is formed to block the rogue electrical impulses. Whether that scar comes from cryo. RF, laser or physical incision is quite irrelevant.

[traveler65 in reply to BobD]

@ BobD Thanks for this info. If I had known that (as in my ep telling me) I w3ould not have bothered to ask if I could stop taking warfarin.

[Beancounter Volunteer]

Hi Salty

I think the other challenge here is define successful ablation.

For most people I suspect this will be a major improvement to the quality of their life, but that does not mean a permanent end to all AF necessarily.

The problem is that you've suffered from AF, therefore absolutely need to be anti-coagulated, there appears to be no argument to this worldwide. Now you have an ablation, or several, BUT you were still an AF sufferer, even though maybe you feel great and are no longer getting any of the symptoms which you had previously, but you could still be getting shorter and perhaps even unknown bouts of AF occuring in your body, and each of those leaves a stroke risk.

The experts appear to be on both sides of this fence, some say definitely carry on after ablation, some say no need.

Mr personal view? is that all other things being equal, and especailly all other things such as conditions which might affect bleed risk, I would stay on the anti-coagulants.

Be well

Ian

[Salty0987 in reply to Beancounter]

Thank you for the response. That is most helpful on my decision. To stay on Eliquis .

[Sebhel]

Me too.

For over 2 years now. Like everyone here, I had to go through the panics and uncertainties of AF discovery. I went through the process of diagnosis, with more worries. Then the waiting to see and discuss my problems with cardiologist, followed by more waiting to see EP, during these long waits my wife and I were more than slightly agitated!

Finally we were presented with our options and asked to make our choices for treatment. With AF This is not a simple clear cut choice! Treatments are based on results of studies and percentage improvement benefits. They explained all this and we had to put our questions in the limited time of our appointments! In ignorance we had to ask the right questions.

Finally the choice was ours, whether to accept their recommendations. But it was the uncertainties that were hard to get used to. All this added to our stress which was definitely bad for the heart!

We all are different with individual symptoms and responses to treatments with unknown future variable outcomes and side effects!

I chose, rightly or wrongly, who knows, not to take the cardioversion possibly followed by ablation treatment as my AF had been with me for a long time

I think was lucky, to be prescribed Apixaban, Eliquis. At first it was scary because of the unknowable risks and "lack of antidote". Plus I had to become twice dayly routine disciplined - not easy in my case!

Then I found this forum and it really helped me, as it has replaced my frantic and aimless Googling! This site which has removed a major risk contributor to my AF which is STRESS AND WORRY,

Thanks to all involved in making this site what it is! It really helps!

Sebhel

[Salty0987 in reply to Sebhel]

Thank you. This blog is most helpful.

[Hidden]

I'm no good at gambling, so it's a no brainer for me, but I respect the right of individual choice......keep taking the tablets!

[Salty0987 in reply to Hidden]

FLapjack... My favorite thing is to play a slot machine ....however, on this one I think I will only gamble on that silly ole machine and NOT gamble on my life. You are right and I will keep taking that pill...thank you.

[Beta44]

The stroke risk study is large and the results look conclusive. On the face of it if you have ablation for AF, whether successful or not, your risk of stroke is normalised. However, one must presume that most of the patients who had ablation were taking anticoagulants. Therefore, I think that they are saying that if you have ablation for AF and take anticoagulants then you have the same stroke risk as someone without AF.

Please correct me if I have missed something

Peter

[traveler65]

My electrophysiologist has me taking warfarin and sotalol ( low dose) for life because there is a statistical record of atrial fibrillation that increases with age. It is possible that you are so otherwise healthy and know all the triggers for afib and avoid them that this may not happen. that you are outside the normal curve of statistics and you are an outlier---very much worse or very much better ( ex. a man who is 7 feet 5 inches tall or who has an IQ of 160 is an outlier at the positive end someone whose IQ is 21 or has a height of 2 feet 9 inches are outliers at the negative end).). I am somewhat in this positon; not being 7 feet tall, but being otherwise extremely healthy andf physically fit. BUT< I still have afib and blood pressure issues. The only way I have kept this normal besides the ablation and the supplements and the diet and avoiding triggers is to take the meds. It's a synergistic effect thqt somehow seems to be neccesary. HOWEVER, suppose you go into abnormal sinus rhthym and an elevated heart rate for what ever reason and however briefly.

this creates the possibility of a stroke or heart attack. Do you really want to risk that? Are you aware of all the triggers? Do you have any vagus nerve issues? Do you tend to sometimes get a dysregulation of the autonomic nervous system?( the flight or fight part kicks in when not required). Your doctor is trying to keep you alive and well. Personally I would rather not take the 2 drugs mentioned above, nor the 2 low dose bp meds I now take. But since the bp is genetic and I have tried every possible combo of non drug ways to have normal bp, and the only thing that works superlatively well is the low dose bp rx. and a slew of antioxidants and foods that maintain normal bp--I have no choice as I prefer to remain alive and well. If you discover better solutions for managing afib , please let me know. By the way, a scientist at Lund University in Sweden in conjunction with scientists in the UK and the USA, has discovered 9 genetic markers, polymorphisms (single nucleotide glitches) that are genetic biomarkers for atrial fibrillation--meaning if you have these in your genetics, then you have the tendency to get afib, even if your relatives don't have afib.

Triggers": alcohol, caffeine, excessive heat eexposure, chocolate, sugar salt, allergens, too much stress, not enough sleep, not enough protein, not enough exercise, too much exercise, large macrolide antibiotics (like biaxin and azithromax), quinolone antibiotics ( like avalox cipro leviquin, any thing ending in floxin, larium), asthma meds, isn,t this crazy??

In the event you need to relax your heart scientific studies have shown that Mozart symjphony 40 in G major does a great job of this== the study also tested with Brahms and ABBA. ABBA provided no lowering of bp, brahms a bit but the mozart won out.

Also if you ask an EP what causes afib--eventhe most brillaint one will tell you he does not exactly know--because they really don't. so given all of this0---- you can see why your dr. wants you on this drug.

[Salty0987 in reply to traveler65]

Thank you for responding. You are very informative and I appreciate all your information.