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How many days would you forfeit your blood thinner?

Clarajoan profile image
33 Replies

Hi, I am now 2 months post ablation- no runs of AFIB, but I have been plagued with some palpatations. That being said, my main concern is repeated gastronomic problems- acid reflux to the point where my voice is raspy and I have a nagging cough. I know that GERD can cause these symptoms, and I have struggled with acid reflux prior to the August ablation; however, since the ablation, things have worsened.

This past week, I was hospitalized with stomach and back pain that moved into my chest. I thought I was having a heart attack, so I rushed home from a luncheon to the bathroom; constant constipation was no longer an issue! The results of the ED visit was : no cardiac issues; however diverticulitis was diagnosed along with the problems associated with Gerd.

While in the hospital, a gastronomic doctor came to see me. She wanted to do an endoscopy that day, but I wasn't cleared by my cardiologist. Well, today, as I sat in the cardio' office, he spoke with the gastro doctor. He told her, " my patient is 2 months post ablation; she can come off of the Eliquis for 48 hours prior to the procedure." The gastro doctor set the endoscopy up for Monday afternoon, without consulting me first. When I got to her office to pick up the paperwork, she told me to stop the Eliquis for 72 hours. When I inquired as to restarting the Eliquis, she said 2 days later!! That's 5 days without the blood thinner.

What do you people think??? You have given me good advice in the past; please weigh in!! ( I am nervous as hell to acquiesce to her demands)!!!

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Clarajoan profile image
Clarajoan
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33 Replies
perkman profile image
perkman

Don't stop longer than your EP stated of 2 days. Anything longer your should contact him immediately to get approval.

Good Luck

Clarajoan profile image
Clarajoan in reply toperkman

I agree... calling my EP first thing Monday.

CDreamer profile image
CDreamer

The risk between clot and bleed is always a very difficult one.

I wonder if your gastro doctor understands that Eliquis half life (the time it is effective within the body) is 12 hours? I wonder if many doctors still believe all anticoagulants behave like Wafarin?

I think in your shoes, I would challenge her and say you are very unhappy with the contradictory advice and would like her to explain to you her reasoning for wanting that, but if you had to choose you would like to follow the advice of your cardiologist (heart first) and stop for 48 hours prior to the procedure and all being well, restart the day after.

I wouldn't do that without negotiating and informing your doctors and seeking a consensus.

A very personal opinion and not advice, but do get your dilemma.

Clarajoan profile image
Clarajoan in reply toCDreamer

I agree... even the ablation did not require 72 hours Eliquis free, and I was started in the medicine the day after. I am very leery of the gastro doctor acting as if she knows more than my EP. I am calling the cardio doc first thing Monday. I will also ask my GP for the name of another gastro doctor.

pottypete1 profile image
pottypete1

When I had a Colonoscopy 2 years ago I was told to stop taking Warfarin for 5 days.

To compensate I was prescribed another drug (can't remember the name) to inject into my tummy which I had to administer myself.

This was to ensure that anticoagulation continued throughout that period.

Pete

BobD profile image
BobDVolunteer in reply topottypete1

clexane Pete.

pottypete1 profile image
pottypete1 in reply toBobD

That's it Bob.

My memory for such things only lasts 15 minutes most of the time unless I write it down.

Hope your Pink Carnation dinner and gathering is a success.

Pete

barbara2 profile image
barbara2 in reply topottypete1

Doctors call this "bridging anticoagulation." That means taking another type of anti-clotting medication that is short-acting -- usually heparin.

pottypete1 profile image
pottypete1 in reply tobarbara2

Yes you are right.

When I severed ghe artery in my left hand 2 years ago (oops) they firstly had to inject me with Vitamin K to counteract the Warfarin and stem the bleeding.

Then when they had completed 3 hours of microsurgery to repair all the nerves tendons and my artery, later that day they then injected me with heparin.

Bit of a drama all round.

Pete

barbara2 profile image
barbara2 in reply topottypete1

I know. Drama...something we don't need more of in our lives. I've read where some docs forgo the heparin for some procedures. And, as I understand it, heparin is not used for the newer anticoagulants? Not sure.

millie-becca-187 profile image
millie-becca-187

I too have to go for an endoscopy on 10th October due to severe gastro problems post ablation (4 month now since ablation) and there has been no mention of stopping any medication except the ppi, omeprazole, which I'm suffering badly from stopping!

CDreamer profile image
CDreamer in reply tomillie-becca-187

Try liquid Gaviscon Advanced, but check is OK. Works very well for me.

millie-becca-187 profile image
millie-becca-187 in reply toCDreamer

I've tried everything, and the only thing that works is omeprazole and the doctor won't prescribe me any more until I've had an endoscopy!

CDreamer profile image
CDreamer in reply tomillie-becca-187

Oh dear, how very uncomfortable for you, but PPIs are not good news long term so I've always avoided them, even though every doctor I have ever seen wants to prescribe them - ironical!

Clarajoan profile image
Clarajoan in reply tomillie-becca-187

I guess the gastro problems post ablation are more common than we are told prior to the procedure.

It was mentioned that a possible " sunburn" to the esphogus is a risk in an ablation. I was told that it does heal over time.

millie-becca-187 profile image
millie-becca-187 in reply toClarajoan

I sure hope so Clarajoan

Vony profile image
Vony

I was scheduled to have a lumbar puncture whilst in hospital in May and only had to be off Eliquis for 48 hours in total. I would not be happy being off it any longer especially with a recent ablation. Best wishes x

Clarajoan profile image
Clarajoan in reply toVony

Thanks. It makes me very nervous to think about 5 days off the meds!

Vony profile image
Vony in reply toClarajoan

Raise your concerns for sure. Best wishes

Dodie117 profile image
Dodie117

I had a colonoscopy and did not stop anticoagulant.

Mike11 profile image
Mike11

I had to come off warfarin for my colonoscopy - also diverticulitis. It is essential to come off anti-coagulants as they may want to take samples in the colon and they don't want the problem of stopping you bleeding. Obviously it's a small risk of stroke but for a week it's not that likely.

Clarajoan profile image
Clarajoan in reply toMike11

If it were a colonoscopy, I would be more inclined to understand the duration of non-Eliquis, but the endoscopy is less invasive. Honestly, I think the gastro doctor is being overly cautious to cover her own butt. I think I need to find a gastro doc willing to work with my EP.

Clarajoan profile image
Clarajoan

Thanks... I am postponing the Endoscopy, and calling my EP first thing Monday. I am also contacting my GP for the name of another gastro doctor.

ILowe profile image
ILowe

CDreamer made a crucial point. Some of the advice you had seems more appropriate to Warfarin than the drug you are on.

For anticoagulation, as said, it is always a good idea to insist that the cardiologists have the major say.

There is a difference of opinion out there. That means, the doctors really should be outlining the possibilities for you, with for and against each of the several options.

Crucially, there are different practices. Power and authority and tradition, with deference to the expert (out of date? fearful of litigation??).

There is also the balance of doubt. In the minds of many doctors, the risks of doing something, like bridging therapy, are acceptable even though there is loads of evidence against them. But the risk of NOT stopping anticoagulation are seen as unacceptable. I think the opposite.

Here is one reference arguing that you do not need to stop anticoagulants. asge.org/docs/default-sourc...

You can only push hard when you know your grounds. So if you do not want to stop anticoagulation, make sure you have loads of references available.

There is also the balance of risk. I for one would far rather face managing a bleed in the colon, than having a clot in the wrong place.

Keep us informed

Clarajoan profile image
Clarajoan in reply toILowe

You hit the nail on the head! I sat and listened to my EP say-" 48 hours"; the gastro doc decided 72. And then told me 2 more days until I resume- that is not what my EP stated.

Even after the 4.5 hours of surgery for the ablation 2 months ago, I was given Eliquis the next day! I am very leery of the gastro' understanding of the need for the anticoagulant; thus I am not going to use her.

I have an appointment with my GP next week, and I will ask for a referral from him. I also think I will wait until the 3 month mark to pursue the endoscopy- I can deal with bland foods for another month.

After all of the upset and worry about the AFIB, and after what may be a successful ablation, I do not want to undo the positive results I have obtained!

Thanks for listening.

irene75359 profile image
irene75359

I had to stop for exactly the same procedure but insisted on bridging - they prescribed fragmin which I self-injected with absolutely no problems at all. Best of luck!

irene75359 profile image
irene75359 in reply toirene75359

I should point out I am on warfarin, only stopped a few days beforehand and a couple of polyps were removed without bleeding.

Ajitriturado profile image
Ajitriturado

I had a comment about your need to rush to the bathroom. It may be related to the vagus nerve, which also controls the heart.

suzytoshoes profile image
suzytoshoes

Hi

I had my blood thinner stopped for 5 days before having pace maker fitted, but went straight back on it after , and they phoned me from the clinic to tell me to get back on it but I had already done so , my INR had dropped very low to 1 so had to increase it for a few days, before I had the pacemaker fitted they had trouble getting blood from me , I think it was because had left me to long without the blood thinner, but everyone is different, but if you are not happy I would ask to restart it again.

Suzy

rothwell profile image
rothwell

I don't like taking Omeprazole but have to because of constant reflux caused by a hiatus hernia. However I now only take 10 mg every other day.On the alternate days I have a cup of hot water with the juice of half a lemon squeezed into it and add half a teaspoon of bicarbonate of soda. An old remedy but it works.DGL liquorice tablets (Amazon) also help. Acid reflux definitely affects my AF.

Clarajoan profile image
Clarajoan in reply torothwell

It creates palpatations for me. I am sure my nagging cough is also gerd. I will try your old remedy!!! Thanks for the information.

Hi Clarajoan,

I am on warfarin (coumadin) for life. I have twice had to come off it for medical procedures. Once for a CT scan and the second for partial knee replacement surgery.

In both cases, I had to stop Warfarin 1 week before the procedure. The knee surgery was by far and away the more challenging and as soon as I came round after surgery and was back in my ward I was given two injections of the bridging anticoagulant Fragmin. Later that day I returned to my normal daily warfarin dose.

No problems.

In both cases it was 29 days before my INR readings returned to the desired theraputic range.

But hey, I'm no medic or doctor or anything but I'm gonna stick my neck out and say that it is always possible that your ablation aggravated the vagal nerve in some wacko way - this nerve controls/regulates many body organs but most notably heart and digestive system. I've managed to tame mine by dramatically changing my food intake and have been AF free since April 2015.

Suggest you Google, vagal or vagus (meaning 'Wandering') nerve and also look at schematic diagrams of this nerve.

Good luck.

John

Clarajoan profile image
Clarajoan

Thank you!

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