It's not safe to stop anti-coagulation after an ablation

[MarkS]

A Swedish review of over 1,000 patients have found that for patients who stopped anti-coags and who had a CHADS2VASC2 score of 2 or higher have over 4 times higher chance of a stroke after an ablation compared with those who remained on anti-coags:

ncbi.nlm.nih.gov/pubmed/278...

[BobD Volunteer]

What we have been saying for years. Once on it .never stop. This was explained at the new Patient support group in Exeter on Friday.

[RichMert in reply to BobD]

Hi Bob, would they have carried out a CHADS2VASC2 blood test following the ablation and during routine blood tests in subsequent months?

[BobD Volunteer in reply to RichMert]

Chadsvasc is not a blood test it is a risk assessment scoring system. Since it can not be deducted from ie even controlled hypertension still carries a score then once given a score that is yours for life or until age adds to it.

The point is that changes to the atrium caused by both the original AF and subsequent ablation can lead to blood pooling and resulting risk of clots forming.

[RichMert in reply to BobD]

Thanks Bob, at 52 I guess at some point I should speak to somebody about risk.

[CDreamer]

Your summary of the report is a little misleading I think, I am no expert but I read it as there is a slightly higher risk for people who discontinued Warfarin after PVI in the first year but a MUCH higher risk for those people who had already had other high risk factors or had stroke or TIA.

My understanding is that you are advised to continue anticoagulation for at least the first -12 months following PVI.

There are some studies from US that show that anti-coagulants stopped after 12 months following a successful PVI with no further AF episodes during those 12 months, and no other risk factors, return to average population risk - but this is not a random selective study and therefore is not considered robust.

[MarkS in reply to CDreamer]

Hi CDreamer,

I think the critical part is: "In patients with a CHA2DS2-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P = .046)".

I guess probably 50% of the people on this board would have a score of 2 or greater. So if they have an ablation then there is still high risk of stroke. If they take continue to take warfarin then that risk falls to less than 20% of what it would have been.

What would be interesting is to see the stats for stroke for people who have never had AF but have a CHADS2VASC score of 2 or more. I know the score gives a good indication of stroke risk even if you don't have AF.