Can i stop apixaban?

[mars1bar]

I had an ablation in 2015 which improved but didn't cure my paroxymal lone AF - I still had about 3 episodes a week (rather than 3 a day). I planned to have another ablation but was diagnosed with a rare form of pancreatic cancer (NET). Luckily I was able to have surgery which entailed removal of 1/2 my pancreas, all my spleen and gall bladder and a piece of liver. That was November 2016. Following surgery I went into AF and was put on a magnesium drip for 4 hrs. Don't really remember what my heart was up to in the next week or so as I was busy concentrating on recovering from surgery.

About a month later I realised I hadn't had a episode of AF for a while and started monitoring again with my Kardia.

I have had no episodes that I have noticed and none has been picked up by my Kardia (I test about twice a day). Previously my AF was really obvious with a heart rate of 150 - 180 bpm. I have had 3 months + clear of AF (Yippee!), whereas before I couldn't go a week without an attack.

I'm wondering if anyone has any idea why my AF has stopped and also whether anyone has stopped their anticoagulants when AF is no longer evident.

Sorry for the long post. Look forward to any comments.

[jeanjeannie50]

Gosh that operation sounds awful, have you recovered fully from it?

I wonder if the cancer in your body was causing your AF. AF can often be traced to some form of inflammation in the body. Its still early days for you, I think you would have to wait a lot longer before even thinking about stopping anticoagulants and some people choose to stay on them for life to prevent against strokes.

Best wishes

Jean

[mars1bar in reply to jeanjeannie50]

Thanks Jean. I'm amazingly well considering which bits are missing from my guts. Actually I'm really happy because in Sept I was given 6 mths to live, but that has changed as they think they have removed all the cancer (previously thought to be inoperable). Phew!

I did wonder about the cancer and AF. I've had AF for maybe 30 years and no idea how long I've had the cancer - its a slow one - only got diagnosed by accident.

I think most people are going to say keep on with anticoagulants. Had a long chat with a great cardiologist who wanted me to stay on them but agreed to organise an echo and holter monitor. I also plan to see an EP who promised me a while ago that he would do another ablation and then take me off NOACS.

I've had brilliant treatment from the Bristol Royal Infirmary (latest CGC outstanding) but will need to see EP privately I think as the wait is so long.....

Thank you for your good wishes

Pat.

[BobD Volunteer]

You can always stop taking anticoagulants but you can't undo a stroke. Even after successful ablation many of us prefer to stay on anticoagulation as there is no evidence to say the risk has gone. Many people are unaware of their events as well so you could be having AF and not aware of it. It is your choice obviously but best intelligence is don't stop or at least not until you have had a long talk with your EP.

[mars1bar in reply to BobD]

I knew you would say that. Good sense I know. I won't stop taking them without a discussion with an EP. See reply to jeanjeannie.

Best regards

Pat

[Hidden]

I wonder if you are concerned about the risk of potential bleeding against the risk of stroke and given your history, this might be a difficult judgement call. I really think you should seek professional medical advice from your EP and the Consultant(s) who performed your cancer surgery, making sure they understand your full medical history. I hope your get it resolved to your satisfation soon. If the risk of bleed is not an issure, I personally would not stop my Apixaban as the risk of stroke gives me the eebbeejeebbees!!!!

[mars1bar in reply to Hidden]

Bleeding is a part of it, but the main reason is that I just want to reduce my medication. I was very happy to take Apixaban when i knew for certain I had AF. Now I probably don't (although its still possible I have it but haven't felt it because its 'different' and has not been it picked up by Kardia). NOACS are still relatively new drugs and have not been tested over long time periods ( they can't have - they have only come in in the last few years?) All drugs have side effects and not all come to light in the early years. Also I know that there have been studies re stopping NOACS following ablation and there have been mixed results. I'm hoping that someone will say " In your case you can stop because............". You will probably say "Dream on...".

It would be really nice to know why it has stopped. Apparently it a progressive disease. so what stopped it - removal of cancer? massive dose of Magnesium IV? Answers on a postcard please.

[Hidden in reply to mars1bar]

I'm saying nowt!! other than wish you well.........like your spirit too!!!

[mars1bar in reply to Hidden]

Thank you!

[Hidden]

Providing no good reason to stop my choice would be to stay on anticoagulants to prevent stroke. Discuss with clinicians and read around it to make informed decisions

[mars1bar in reply to Hidden]

Thanks. I'm doing my research - part of which is posting here of course.

I now have an appt next weekwith my favourite rock climber/EP Glyn Thomas and will see what he has to say.

[Hidden in reply to mars1bar]

Let us know

[Mazza23]

After all you have been through please don't risk a stroke AF can pop up at anytime so better to be covered, your choice of cause but you did ask I wish you well in your recovery , my sister had a similar op 2years ago unfortunately her outcome wasn't good god bless her

[mars1bar in reply to Mazza23]

So sorry to hear about your sister. I am so far very lucky but not sure what is in the future of course. Thank you for your advice and good wishes.

[nymima01]

Lowest dose is 2.5 mgs. If you have no side-effects, why not? My mother is on this dose 2x a day. She is 91 yrs old. She has afib and refuses to go to the next dose of 5 mgs. like her cardiologist wants her to. She is a bleed risk, but she has NOT had a bleed from Eliquis since she is on it - over 4 yrs now.

[mars1bar]

I might have had a bleed - did have blood in urine twice in quick succession but that meant I had scans for bladder and kidneys.

They were fine but along the way my cancer was picked up and hopefully removed so I guess I should be really glad that blood appeared.

[mars1bar]

Saw the EP today. Showed him my Kardia report - zero AF Jan and Feb compared with quite a few episodes in Oct and Nov. (no records for Nov and Dec due to surgery). Also discussed the fact that I always know when I am in Af. His advice was to stop medication but if I started in AF again just start medication. He said that the heart can sometimes mend itself and its possible that that's what mine did.

He also mentioned that this approach is not for everyone - it would not be suited of course to those who are not sure whether they are in AF or not. BTW my CHADSVASC score is just 2 (female and 66) so not a very high risk.

Thanks to everyone who responded to my post and sent good wishes. I hope you find my EP's views interesting and encouraging.

Pat.