Time to go off Pradaxa?

[Jhcoop55]

I am 62, very fit, and have no other heart related conditions. I have not had an AFIB incident since my second ablation over 13 months ago. My Chad Vas score is zero. I am still on a low dose regimen of Flecainide and Metropolol to control ectopics, but not for AFIB I take 150 mg Pradaxa 2x per day I recently spoke to my EP who indicated that it is my decision as to whether to go off the anticoagulant but he noted that he was comfortable with me going off the drug given my low Chad Vas score Of course he did mention that the risk of stroke while low, still is a bit higher than the general population given my prior history with AFIB and the possibility of it coming back in the future

While I have not experienced any noticeable side effects with Pradaxa, I’m worried that the bleeding risk given my active lifestyle (cyclist, skier, etc) may outweigh a relatively low (albeit debilitating) stroke risk I’m also concerned that while there is a reversal agent for Pradax, not all hospitals have them readily available Two questions:

Any thoughts given the above facts as to whether I should go off Pradaxa? I’m leaning towards going off Pradaxa but would like more input

Is anyone aware of any studies that measure stroke risk following a “successful” ablation with no other heart related conditions?

Thanks much

[CDreamer]

Watch John Boy’s recently posted video.

I posted almost exactly the same 3-4 years ago. No matter what the trials or studies show or say, basically it is a lottery, I was very resistant to anticoagulatjon AND I had no AF episodes after ablations but have now done a 180 deg turnaround, I recently had a TIA on anticoagulation.

I think on balance I would rather have a bleed - as often that can be treated - than a stroke, which cannot be undone.

But it is a very personal choice which only you can decide.

[jennydog]

CDreamer had replied with her usual wisdom. I also take Pradaxa and consider it to be my best friend.

You are not getting younger and when you reach 65 your score is likely to rise. Meantime you are prescribed a very expensive drug and I suspect that if you were to come off it then there would be resistance about you restarting it.

[BobD Volunteer]

There is a school of thought which says that stroke risk is not affected by ablation. In fact the very ablation may induce a risk due to the changes in the surface of the atrium which can create some eddying and possible pooling. The people I trust say keep going but it is your choice. If it causes you no problems .(like warfarin and I ) then what take a risk?

[cassie46]

I mentioned in another post a few weeks ago when anidotes were mentioned. My dad was on warafin for over 10 years. He had many visits to A & E over this time with extreme nose bleeds lasting two days, quite a few bad wounds form falls and badly cutting himself, often having to say in for a few days.

He was never once given the warafin antedote, it was always special pressure pads and for his nose bleeds a special pack proceedure performed by ENT. I am rivaroxaban so have no concerns about bad bleeds.

Cassie

[Hidden]

I was a cardio bunny for many years. In my 60s I was advised not to have an anticoagulant because of a bleed risk, my CHADVASC was 1 because I was older than 65, my body fat was less than 10%, and a typical gym session would be 12.5km on a Concept 2 rowing machine followed by 4 x 5 minute sessions on a Marpo rope machine, then yoga stretches. One day I went into the garden shed, fell over and was instantly and permanently blind on the right hand side: I had had a full stroke. I lost my licence, I had to re-learn how to use a computer and, I couldn't remember how to get to places. Before the stroke I could row 5km on a Concept 2 in 22 minutes at full resistance. Andrew Marr was trying for 20 minutes when he had a stroke.

There was no reason other than exercise induced AF that only dropped my power output by 8 to 10% on a Cyclops turbo trainer to think I was a stroke risk. If I had known that I would have taken an anticoagulant. I believed my fitness, body metrics and diet regime would protect me: it didn't.

[Jhcoop55 in reply to Hidden]

Thanks John-Boy. Hope your recovery from your stroke has gone well.

Thanks for your information. May need to rethink my decision but now leaning towards staying on the drug

Just curious, prior to your stroke, did you have an ablation and if so had you experienced any AFIB related events? If not, we’re you on meds and was your AFIB under control? Do you think your exercise contributed to your situation?

Jeff

[Hidden in reply to Jhcoop55]

I wasn't offered an ablation as I was deemed to be low risk and at my age ablation is unlikely to be successful. AF has never bothered me except when I had a caffeine gel before a 10k run. I wasn't on medication as I been recommended not to take an anticoagulant. In theory my exercise should have saved me from a stroke.

[Jhcoop55]

Thanks John-Boy. I’d like to think that my risk is/was a little lower than yours since I was able to have an ablation that eventually was successful (however long it last). Nevertheless, you and others have convinced me that the risk for stroke is still higher than the population as a whole that has never had AF and since Pradaxa causes me no side effects other than the bleed risk, I’ll stick with it.

As an aside, interestingly, I’ve read that excessive exercise can lead to AF. I’m convinced that is what happened to me. I I became a long distance cyclist about 7 years ago and increased my miles substantially to 8000 miles per year following my retirement three years ago. At the end of my record year of cycling, I had my first AFIB episode (while riding) that went undiagnosed despite extensive testing (ekg, stress test etc.). Didn’t experience another episode for another 12 months before tests finally identified the problem while I was in The emergency room. I’m good now following the ablation (other than the PACs and still cycle but at a much more moderate rate.