Apixaban double-edged sword?

[Melchet]

Any comments please on whether I should be taking Apixaban after AF ablation?

I had a successful PVI Cryoablation in August 2018 which has fixed my PAF for the time being. In preparation for ablation, the EP put me on 2x5mg Apixaban in place of the soluble aspirin I had been taking. At my 1 year check-up, the young registrar suggested I should stop Apixaban but did not object when I insisted that I wanted to remain on it to minimise stroke risk.

I am being investigated for anaemia which I had long before starting Apixaban. I had a recent colonoscopy which showed some damage and bleeding from veins in the sigmoid. Following a recent blood test, the GP said I had abnormal clotting factor (did not explain fully) and should come off Apixaban while my anaemia was being investigated, based on the registrar's view that I should stop taking it.

I'm a 67yo male with hypertension, so my CHADSVASC score is 2. I am anxious that I am no longer protected, but also mindful that my 91yo mother-in-law was on Apixaban and recently suffered a devastating hemorrhagic stroke.

[Slattery]

I am. 71 year old female in good health other than Afib. I had an Ablation 4 months ago and I feel great! My doctor took me off anticoagulants yesterday. I live in the US, doctors here do not like long term anticoagulants unless you have health problems that may cause a stroke. There are two different schools of thought on this subject. For now I will follow my EP’s instructions. I wish you the very best.

[Melchet in reply to Slattery]

Hi Slattery, thanks for your reply. Interesting that advice on NOACS post AF ablation differs in the US. In the U.K. they use CHADVASC scoring to assess stroke risk? Great to hear that you had a successful ablation and wish you all the best!

[CookieinAL in reply to Slattery]

Much like you, I am also 71 and 4 months post ablation, but my EP has continued my Eliquis at least until February.

[Bagrat]

As well as chads2vasc score there is the hasbled score to consider and your medical practitioner should take that into account too. The doctor has to weigh up the advantages and risks and of course we can think about it too and be included in the decision making.

Doctors are influenced by their experiences with many patients sometimes ( rather than by valid research) as we are by ours with friends and family members.

[BobD Volunteer in reply to Bagrat]

Just to make a point here, HASBLED is not a scoring system to contra CHADS2VASC. It is an aide memoir of things to address when considering anticoagulation. , For example Hypertension needs to be controlled etc. It is a common missconceeption that one counts scores and compares but a leading doctor put me right on that at HRC Patient's Day a few years ago.

[Bagrat in reply to BobD]

Thanks BobD poor wording on my part.

[CDreamer]

Everyone’s circumstances are different so in yours I think it wise to follow your doctor’s advice, although you may want to take a second opinion?

I also have anaemia & tested for B12/folate which is ok so now looking at microscopic bleeding but haven’t been advised to stop.

Did you ask for the doctor’s reasoning for stopping? Maybe worth asking as it will always be a calculated risk assessment on whether or not bleed risk outweighs the stroke risk - these decisions are rarely made rationally by ourselves and are usually driven by what we fear most.

[Bagrat]

If you are unclear as to what GP means by clotting disorder I would be inclined to go back and ask. It might be reasonable to request a referral to a haematologist as they are the experts in these matters

[CDreamer in reply to Bagrat]

Good advice.

[Melchet in reply to Bagrat]

Thanks Bagrat and others for your wise counsel. I’ll seek clarification from my GP and discuss a possible referral to haematologist. Not had B12 or thyroid blood check yet which may be relevant for anaemia.

[dave1950]

I couldn't and wouldn't want to comment on what's best for you. But here (the UK) I was told that any AF, even if you only have it once, increases your stroke risk by a factor of at least 5x. Mine was previously minimal (Never smoked, don't drink much, normal weight) but aged 69. SO I was put on Apixaban (I was told that aspirin would be useless as anti-coagulant) and to me it is brilliant compared to what I imagine Warfarin must have been like. Zero side effects for me. If I cut myself perhaps it takes a while longer to stop bleeding but nothing significant so far.

[Jjda]

How lucky are you not to be female, or your score would be a 3, and an automatic sentence to anti coagulants. My EP and I argue regularly about the pros and cons of Eliquis, but in August, a year after my ablation, he agreed to giving me a loop recorder and if I have no AFib for another year, he will consider taking me off it. I have to admit that I have not had any side effects, however, lab work had shown some differences in kidney tests since I went on Eliquis, so we are keeping an eye on those.