Blood thinners - how long?

[Jafib]

When I first met my ablation doctor he told me I would be on my meds for about three months post ablation and then we would stop them and see how it goes. I was sure to ask about the blood thinners as well and he said that would be stopped shortly after. Well, I am of all meds and heart seems mostly good. So, I asked if I could stop my blood thinners and the response I got was, “Typically you are on the blood thinner for 1 year after the ablation. Dr X recommends that if you want to stop it sooner you would need an implantable vs wearable monitor. He is asking that you schedule an office visit to discuss this further.” Is this normal procedure? I wasn’t on blood thinners before my ablation and now after the ablation my heart seems good and they want me to be on them for a year?? Thoughts??

[Jafib]

And nobody ever mentioned any kind of monitors - wearable, implantable or otherwise...

[CDreamer in reply to Jafib]

I am assuming you weren’t on anti-coagulants because your CHADSVASC score = 0?

After the ablation you will experience some disturbances within the heart after you have had such an invasive procedure - which in itself could cause a clot to form so you would need to take them for some time to be sure you weren’t developing a clot or having any AF. I am sure would have had to have been on anti-coagulants for a few weeks prior to the ablation for the same reason.

My EP was very reluctant to agree for me to come off anti-coagulation after ablation, period, but agreed if I had no recordable AF episodes but didn’t insist. I had just over a year off them, then had 1 very short episode of AF and panicked and went straight back on them and had a TIA anyway and now will taking them for life. Once I reached 65 it was an insist anyway and I was about to reach that grand old age.

It will depend on many risk factors - CHADS score, age, monitoring but the latest advice in the UK is if you have had AF then you would be probably gain by staying on anti-coagulants for life. And the advice is constantly changing as more evidence arises.

I think choices around anti-coagulants are very personal and usually driven by fear - am I more afraid of stroking out because I am not on anti-coagulants than risk of bleed or side effects from them? We make these decisions based on emotion rather than evidence or regardless of any assessment based on risk scores or medical opinion - which varies - hugely!

Personally I was convinced to stay on them because I found the evidence overwhelming but everyone must make up their own mind with the guidance of their doctors, but please do your own research and the AFA website is a great place to start.

heartrhythmalliance.org/afa...

[Jafib in reply to CDreamer]

Hey CD. I was placed on the anti-coagulant a month before the ablation (December 3rd) and for a few months after as standard procedure.

[BobD Volunteer]

Here in UK we prefer to call them what they are, Anticoagulants, as of course they do not thin blood at all. Their purpose is to reduce the risk of clots forming.

The wisdom is that if your risk of stroke measured by CHADS2VASC2 is low then anticoagulation may only be required for the period of three months prior to the procedure and till full recovery and cessation of any AF. It has also been noted over time that the very procedure of ablation can change the internal surface of the heart and make it possible for the blood to eddie and possibly cause clots to form in stagnant areas.

There is also the possibility that AF can occur which the patient is quite unaware of and I guess that this is the thinking behind the monitor.

Many of us already had scores making anticoagulation desirable and for us anticoagulation is for life even after apparently successful ablations. With the vast proportion of people largely unaffected by taking these drugs it really is common sense.

[Hidden in reply to BobD]

I'll add that your chance of stroke is the same if you are in AF or in NSR so you shouldn't stop taking them just because you are now in sinus rhythm

[Jafib in reply to Hidden]

AF doesn’t raise the risk of stroke?

[Hidden in reply to Jafib]

Having AF does, being in AF doesn't

[Hidden in reply to Hidden]

This video may help youtube.com/watch?v=CwX7xs_...(Not working as expected?)

All of the Videos by Dr Gupta are brilliant

[Jafib in reply to Hidden]

Wow, that flies in the face of what I have been taught about AF and stroke. I have been taught that when in AF the irregular beats cause an eddy or pool of blood that is stagnant and could cause a stroke. I have also been taught that if an AF episode lasts longer than 24/48 hours that I you need to see the doctor. You wouldn’t think it would be a huge rush if the video is correct.

Have other doctors said they agree with the conclusions of this study?

[Hidden in reply to Jafib]

It's the general consensus in the UK as far as I believe.

My EP certainly agrees with this

[Jafib in reply to Hidden]

Again...wow! Changes how I consider anti-cuagulants.

[BobD Volunteer in reply to Jafib]

And do remember that here in UK we are not the most proactive country in Europe regarding anticoagulation and still could stop an additonal 8000 or so strokes a year if we were.

[S11m in reply to Hidden]

Dr Gupta says that 51 out of 2,580 patients had strokes within 3½ years... that is 5.8 per year per thousand.

Yesterday my doc gave me a print-out (Hull university document HEY-795/2016) which states that anticoagulants decreases strokes from 40 to 14 per thousand per year.

I expect that the pharmas would quote this as a 65% reduction in strokes! (40-14)/40.

[Jafib in reply to BobD]

So...EVERYONE in the UK prefers to call them by what they actually are? Sorry for being a dumb American! Actually, I do know exactly what they do and what they don't do but old habits die hard! I promise to try to be more UK like in the future and refer to them properly. Soooo, back to blood thinners...just kidding! I have never had a stroke risk assessment done. Is it something I can do on my own or must it be administered by a doctor? You know, I would not mind being on the Eliquis at all other than it keeps me from taking other things that used to help me along in life - like ibuprofen. I am struggling with low back pain right now and all I can do is stretch, ice it and go to the chiropractor. Ibuprofen would be wonderful about right now. Same with headaches. They say to take Tylenol, which is about as effective as taking a pill full of air. I am going to start a post on this topic because I wonder what people do to manage pain when it seems most medicines are contraindicated when on anticoagulants.

[BobD Volunteer in reply to Jafib]

Google CHADS2Vasc2 and do your own stroke assesment. Just understand that anything on the list counts even if treated, so for instance blood pressure counts even if controlled by drugs, ditto diabetes .