I wonder if I could let me know your experiences with pre ablation blood thinners. I was diagnosed with PAF this summer and I’m considered low risk so currently on the pill in the pocket regime and no anticoagulants.
I may of miss heard but I thought my EP said start 3 months before the procedure and he set me up for an appointment for yesterday with a view to doing the ablation in “January” (they have since lost half my notes so heaven knows when it will actually happen). When I went to the anti coagulant clinic yesterday the nurse read that the EP wanted me to start them 7 days before hand.
I was wondering what your time line was for starting blood thinners prior to an ablation?
The nurse may have meant STOP them seven days before but this is old fashoined now and many EPs do ablations while the patient is still anticoagulated.
Please understand these drugs do not thin blood. It is a quite incorect term for what they do but sadly is in common missuse these days. They slow down the clotting process to help prevent strokes and being anticoagulated for three months prior to ablation helps to ensure that there are no clots sitting in the heart which may be ejected and cause a stroke. Your blood does not change viscosity at all.
To conclude I suggest that you write to the EP and clarify the situation for the clinic as you really would be at risk otherwise.
Just double checked with the Doctor and he says the nurse was correct, take them one week beforehand and not on the morning of the ablation. I then take them for 3 months after that.
VERY strange. No doubt not warfarin which needs to be got into range well before. I suspect they will then do a TOE (trans oesophageal echocardiogram ) before the procedure to check for any clots which may have formed. I wonder why you thought he said three months?
I would also query why they want you to stop on the morning of the procedure. It is during the ablation that it is most important to be anticoagulated with a proper anticoagulant (i.e. warfarin or an NOAC and not heparin or the other "bridging" anticoagulants).
For me I am on Warfarin. I have had a number of ablations and I have always had to prove that I had an INR of between 2-3 for 4 weeks prior ti the procedure.
It seems that there are a lot of different approaches to anticoagulation but I believe my hospital’s approach can be relied upon as it is considered to be a center of excellence in the UK.
Originally I was on Apsirin in 2013 and when I was listed for an ablation New Years 2014 I was also commenced on Warfarin. It took me 3 months to get in range and it wasn't until July that I had it done. I was allowed to stop warfarin 6 weeks post each ablation.
When I developed Atrial flutter in 2017 I was put on apixaban, primarily because it took me so long to get into the required range on Warfarin. This continued over both flutter ablations in 2017 and was stopped earlier this year when all my medications were stopped.
When I saw EP in the summer, Apixaban was talked about because any anticoagulant has always been at odds with my anti-inflammatory painkillers for my knee condition (ie I can't take them if on Warfarin etc)
At the time I'd got a torn meniscus I was trying to manage and avoid surgery. EP made it clear I didn't need to be on Apixaban until roughly a week before surgery (which meant I'd probably only need to start it at pre-op) and continue on it for a period afterwards.
This also had a side note that if it was going to be an ablation for flutter like the previous 2, then I'd not need to be on it but if it was a full PVI ablation on the left hand side, he would prefer me on it.
It took me ages yesterday but I finally found a study which mentioned only needing to take a NOAC 7 days pre ablation and that they usually do a TOE as well. Did they do a TOE for you?
I had a TOE before my scheduled ablation in August and they found a blood clot so couldn’t go ahead with the procedure. I had to wait for the clot to dissolve and went back to try again 6 weeks later. They did a TOE that tune too and thankfully there were no clots in sight. I’m in Australia though so not sure of the standard procedures in the UK.
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