In some rare research, where MRI scans of the brain were taken before and after AF ablation, the scans showed a high rate of new brain lesions with interrupted NOACs compared with uninterrupted warfarin. This occurred even with bridging with heparin.
The article says uninterrupted NOACs are fine and as good as uninterrupted warfarin. However the old method of ablations was to interrupt NOACs. There may still be EPs in the UK who do interrupt before an ablation and bridge with heparin. So I hope anyone going for an ablation will check they will be uninterrupted whatever their anti-coag - and find a new EP if they are still following the out-dated procedure!
Brain lesions are asymptomatic at the time but are associated with cognitive decline and dementia.
Written by
MarkS
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Makes sense to me and I always blamed the GA. I think many EPs these day do not interrupt warfarin although my first two (of three) ablations I did. I suspect the culprit is micro embolii.
This research joins my file of articles I need handy in an 'emergency box' for arguing with doctors. If someone proposes the 'Heparin Bridge' to me for any reason, this is one more serious risk factor to be put into the risks-benefits equations. Thanks for posting.
You ask good questions. Off the top of my head, here are some possible answers:
1. There is too much research, so that even a consultant who supervises doctoral work etc cannot keep up with it. I knew a consultant (for a different disease) who encouraged me to read, then print out the articles, and bring them to him for comment. He was gracious enough to say sometimes: I did not know that, the article is helpful. Other times he put me right: the larger perspective of the expert clicked in.
2. Most doctors are very conservative and rely on the older ways.
3. There is the legal threat: if they do something new, they could be sued.
4. The NICE guidelines have the effect of tying the hands of doctors, so that even when they know the guidelines are wrong for your case, they have to apply them.
5. Their balance of risk -- benefit, for each factor, is different to mine.
6. They are afraid of what their colleagues might think.
7. They are constrained by their colleagues, or 'the system'. Standard procedure etc
8. Even if they know that the heparin bridge is dangerous, they will do it. Problems with the bridge will go without notice or retribution. The slightest mistake with an innovator will be jumped on.
9. Over-medicine. The demand to 'do something'. The clear example of this is bypass surgery. Most is not needed since the body self-repairs. Deaths due to bypass surgery are accepted. Any death due to NOT operating would create a scandal.
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