Eliquis and surgery

[Oldcarol]

Eliquis and surgery. My EP says 5 days off eliquis before carpal tunnel surgery( which is very minor compared to something else ) and off 2 days after surgery. All the literature I can find says this is excessive. I am more scared of a stroke than the pain from the carpal tunnel.

[BobD Volunteer]

Sounds highly excessive to me as well. Why not ask the surgeon who will do your wrist rather than the EP . This is who matters!

[Oldcarol in reply to BobD]

Thanks. I did. He goes by the EP recommendation. Afraid he will be sued I guess. I think I have decided my carpal tunnel isn’t so bad compared to my risk. I still have irregular episodes of afib, but

They only last a few minutes. Nothing like before my ablation. I can usually take a deep breath and it stops.

[doodle68]

Hi OldCarol I was recently reading ''The 2018 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation:''

The use of this medication is so new recommended measures for uses are still being formulated.

If you follow the link below, then click on the ''Full Guide (pdf) / In European Heart Journal'' then go to Section12 page 1358 and there is a section on 'Invasive Procedures' which may be of interest to you. This is very up to date information ...

escardio.org/Guidelines/Rec...

A section from that article..

[Patients undergoing a planned invasive procedure, surgery or ablation. When to stop non-vitamin K antagonist oral anticoagulants?

About one quarter of anticoagulated patients require temporary cessation for a planned intervention within 2 years. Awaiting the results of the ongoing Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE; NCT02228798) study, few prospective data on the management of NOACs are available Various societies have issued separate guidelines on the timing of NOAC interruption prior to surgery or interventions. It is impossible to summarize all recommendations, and healthcare providers are recommended to check this guide’s recommendations against the relevant recommendations of their country/healthcare setting and professional society. The EHRA practical guide intends to provide a unified approach, which is as simplified as possible to allow its broad implementation. Patient characteristics (including age, history of bleeding complications, concomitant medication, and kidney function), as well as surgical factors, need to be taken into account to determine when to discontinue and restart a NOAC. While invasive surgical interventions require temporary discontinuation of a NOAC, many less invasive procedures carry a relatively low bleeding risk and do not necessarily require discontinuation All patients undergoing a planned intervention as well as caregivers (primary care physician etc.) should receive a written note indicating the anticipated date and time of their intervention as well as the date and time of the last intake of their NOAC (and any other medication) .

Minor bleeding risk. It is recommended not to interrupt oral anticoagulation for most minor surgical procedures and those procedures where bleeding is easily controllable. In general, these procedures can be performed 12–24 h after the last NOAC intake. It may be practical to have the intervention scheduled 18–24 h after the last NOAC intake and then restart 6 h later (skipping one dose of dabigatran or apixaban or no dose of edoxaban or rivaroxaban). The patient may only leave the ambulatory practice/outpatient clinic/hospital if any peri-interventional bleeding has completely stopped. Moreover, application and effect of idarucizumab and andexanetalpha is still pending, the drug is not yet approved and not yet available.

June 2018 ]

[JaneFinn in reply to doodle68]

Very interesting - thanks, doodle x

[Oldcarol in reply to doodle68]

Thanks so much for that link.

[Bshersey]

I had a colonoscopy two weeks ago and my doctor told me to go off Eliquis a week beforehand. And then told me to go back on a day after the procedure.

[C66t in reply to Bshersey]

Gosh that sounds strange. My ep said 48hrs b4 ablation workd grnd. 48hrs b4 colonoscopy and gastropy with biopsies and tg I had no problems. Best of luck.

[rosyG]

particularly as carpal tunnel bleeding would be easily accessible to the surgeon....

[wilsond]

I would query that with the surgeon doing your hand. X

[Oldcarol in reply to wilsond]

I did consult the surgeon. He goes on recommendation of EP. afraid of a lawsuit I guess even though he thinks it is excessive also. Thanks for input.

[doodle68 in reply to Oldcarol]

Hi Carol Also in the ESC article there are sections about the need to strictly adhere to taking the NOACS as prescribed (page1335 ), this is an example...

Quote...

''It is critically important to educate patients at each visit about the modalities of intake the importance of strict adherence to the prescribed dosing regimen, how to deal with any lapse in dosing, and to be careful not to leave their medication behind when travelling''

I can only speak for myself , I have a CHDVAS score of 3 which influences my opinion somewhat (as well as regular episodes of P-AF) and there is no way I would cease to take Apixaban for 5 days when it has a half life of 12 hours and I would argue my case with anyone. I would actually print out the article and send it to my EP for consideration.

[Oldcarol in reply to doodle68]

Thanks. I had ablation 2 years ago but still have irregular episodes of afib that only lasts few minutes, ( that I am aware of) but 5 days sounds absolutely crazy to me and this EP has Top reputation in my area. I’m going for 48 hours off my eliquis and not tell him. Or cance carpal tunnel. Lol. It don’t seem to hurt so much anymore.

[doodle68 in reply to Oldcarol]

Good luck Carol I hope it all goes well .

[wilsond]

Good for you,I share your thinking about tbe risk of stroke for such a relativley minor proceedure! Good grief,my dad had a hip fracture operation last year and was only off warfarin 3 days!

Take care and let us know..xx

[glenpointe]

My EP told me to stop one day before my dental implant and to start it back a day after.