Blood thinners before ablation?

[Vandalbragg]

I spoke with two different doctors and they both recommended cryo ablation. One said I needed to be on blood thinners before the procedure, the other said it wasn’t necessary. What’s everyone’s experience with this?

[Xerxes8840]

Not a doc, but if you’re having AFIB, you should be on blood thinner- just stop 24-48 hours before procedure.

[Vandalbragg in reply to Xerxes8840]

I have no other risk factors so I get a pass on those. Baby aspirin is all I need according to docs in the USA.

[Hidden]

I'm in the States and had an ablation in Dec 2017. My EP wouldn't do the procedure unless I was on Xarelto. He wanted me to stay on it for 6 months, but I had such a hard time being on it, he told me to switch to baby aspirin 3 weeks after the ablation. I've been on it ever since.

I was on Warfarin 5 years ago, when I was first diagnosed, which I preferred to Xarelto, but it was a combination of the timing before the procedure and complications of switching from Xarelto to Warfarin that led to me to stay on Xarelto.

As much as I hate Xarelto, I was fine with being on it for that time close to the procedure. I actually had more episodes when I was on it cause it had such an intense impact on my sensitive system. In spite of that, I'd want to be on anti-coagulation for an ablation.

[Kaz747 in reply to Hidden]

Hi Nella, can I ask what sort of issues you had with Xarelto?

[Hidden in reply to Kaz747]

Hi Kaz, I’m really sensitive and the cardios insisted that the dose is one-size-fits-all. If the normal status of my nervous system was relatively calm, even with the occasional AF episode, with Xarelto in me, it felt like a really pushy bully had moved in, amping things up. Really uncomfortable, messed with my sleep, too, so I’d have more episodes.

I much preferred Warfarin.

[CDreamer]

The European and US advice is different, aspirin is not prescribed in Europe by EPs having thought to have no value in preventing clots forming in AF patients as it is an antiplatelet not anticoagulant and carries a higher risk of GI bleeding.

I had to be on anticoagulants for 2 weeks prior to ablation - regardless of risk factors. Most people tolerate them very well.

[SJB1234]

I am having ablation on 8th February and have been told not to take Apixaban on night or morning before. Hope that helps.

[MarkS]

I would suggest you still need to be fully anticoagulated. Ablation can produce microemboli which produce silent cerebral ischemia (i.e. tiny clots which lodge in the brain). RF ablations produce between 2 and 4 times as many as a cryoablation, see:

ncbi.nlm.nih.gov/pubmed/195...

Nevertheless, the fewer microemboli the better.

Particularly with RF ablation continuous anticoagulation with NOACs or warfarin is really important and the bridging techniques with heparin do not work as well.

[Hidden]

Even with my situation, which is probably unusual (I typically don't fall into the "works for most people" category because of my sensitivity), I would want to take Xarelto or Warfarin for an ablation. In my experience, EPs and cardios, even in the same practice, can approach treatment rather differently (example to follow). If my doc was suggesting that I'd be fine with baby aspirin for an ablation, I'd most likely seek another opinion - yes, I say this even though I started taking aspirin afterwards. It seems rather risky to me to take only aspirin for an ablation and would make me question other aspects of the doc's approach and care.

In discussing the matter with my EP prior to my ablation, he was rather adamant in saying, "I can't do an ablation without anti-coagulation!" I got the point! What I like about this guy is that he listens to my concerns and gets that I'm sensitive and is flexible about certain things, but is also clear about where he can't flex. This has helped me to trust him.

Part of the adventure of dealing with AF is determining these personal decision factors. At what point am I comfortable with a particular doc's approach and information? That's the challenge and is highly personal.

The on-call EP I happened to get one evening a few months ago insisted that I needed to get on the schedule for an ablation or else I wouldn't be able to work because my AF would be so bad. The guy didn't even know me and left me frightened, feeling dismissed, and wanting to slap him. When I saw my EP a few weeks later, he didn't recommend another ablation. Since then, with other changes I've experienced, he now says it's up to me.

After sharing with folks on an AF email list that I was considering another ablation, a person suggested I ask my EP what his success rate is as part of my decision-making process. At this point, that information would not be important at all to me; apparently for him, it would be.

I do think that sorting through the information and various approaches is the greatest challenge in dealing with AF (apart from when the symptoms are particularly awful, of course!) In my experience, it takes quite focused discernment and courage, but is well worth the effort.