Pre-ablation NOAC

[Mejulie69]

If Apixaban has a short half life, why do I have to take it one month before my ablation? Doesn’t make sense!

[CDreamer]

Yes it does.

You need to be anti-coagulated for 4 weeks before ablation to ensure that you don’t throw a clot which can happen several weeks after a AF episode.

The half life refers to how long a substance takes to clear your system - not build up in your system.

The balance between anticoagulation and bleed risk is carefully managed so I suspect you will be asked to stop taking your anticoagulant - assuming it is a DOAC - approx 24 hours before the ablation is scheduled but your EP will explain their preference at the pre-procedure assessment.

Hope that helps.

[MarkS in reply to CDreamer]

Just for clarification, the recommendation is now not to stop DOAC or warfarin 24 hours before an ablation. It's really important that anti-coagulation is continued through ablation to give protection from the micro-thombi (small clots) produced during the ablation procedure itself which can cause long term damage to the brain.

[CDreamer in reply to MarkS]

And my understanding is that is done by injection during the procedure.

[MarkS in reply to CDreamer]

Interrupting the OAC and bridging with a heparin injection has been found to increase thromboembolic events 13 times compared with uniterrupted OAC in a recent review. EPs who interrupt warfarin or NOAC coagulation need to get up to date.

[CDreamer in reply to MarkS]

Interesting - thank you.

[Hidden]

To ensure that blood clots do not form and go unnoticed in this period of time?

[Mejulie69]

Oh I see. I assumed it was for clot protection during the ablation itself. Makes sense now, many thanks.

[UScore]

Yes, I had to do 6 weeks before, and I'll do 3 months afterwards.

And I'm not to take any on the morning of the ablation itself, (so I think it'll be about 18/19 hours since the last dose at the time of the ablation).

[Mejulie69 in reply to UScore]

When is yours?

[UScore]

When is your ablation?

[Mejulie69 in reply to UScore]

12th Feb. Getting close!!!

[UScore in reply to Mejulie69]

Ooh, mine's on the 13th Feb! Have you had a pre-op assessment yet? I had mine last week.

[Mejulie69 in reply to UScore]

Not yet - I am of to Fuerteventura tomorrow for a week and will have mine when I get back.

[UScore in reply to Mejulie69]

Very nice! Hope you have a great (and relaxing) time.

I found the pre-op very useful, they explained about the procedure itself, and went through all the ins and out of what to do on the day itself, and the recovery period.

[browng]

Fascinating divergence of timescales. My EP only required that I was taking Rivaroxaban for the 7 days prior to the Ablation and then 6 weeks thereafter. Following an electro cardio version (ECV) during the 6 weeks we agreed that I should stay on it until the three months review just in case there was another episode which required the ECV.

Towards the end of the period I started passing blood in my urine so the Rivaroxaban was stopped and I had a series of tests to make sure I had no bladder problems including a CT scan.

[KipperJohn]

Before both my ablations I had to have a camera inserted under sedation to also check for clots - done a few days in advance - day visit only.