Ablation and blood thinners

[Lindaj754]

Understanding that we are all different, been reading various opinions on anticoagulation of females who have 2 points ,age and sex, following ablation. Should this be continued for life or stopped if ablation were to be successful?

[Finvola]

The view currently amongst many leading arrhythmia experts is that it is not AF alone which causes strokes but ‘the company which AF keeps’.

As our CHADs score only ever increases, even if, for example, hypertension is successfully treated, then we are still at the same degree of stroke risk. Ablation or successful drug therapy does not cure AF nor remove our CHADs score. I suspect there is still much to be revealed about exactly how people with AF are more susceptible to stroke.

[Lindaj754 in reply to Finvola]

Thank you for this. I had read that some doctors were continuing with anticoagulants for three months following ablation and I was a little unsure as to how that reduced the CHADS score

[Hidden in reply to Lindaj754]

That is normally a precautionary and not connected to the CHADs scoring process. If the EP feels that there is a chance that a blood clot could form and subsequently be dislodged during or immediately after an ablation, then they will put the patient on an anticoagulant. It is very common for this to happen......

[Hidden in reply to Finvola]

"The view currently amongst many leading arrhythmia experts is that it is not AF alone which causes strokes but ‘the company which AF keeps’."

Can I ask what that means (i.e. the company AF keeps)?

[Hidden in reply to Hidden]

The other conditions which are associated with AF such as hypertension, diabetes etc

[Finvola in reply to Hidden]

This whole area interests me as I feel there is an unknown at work here. As FlapJack says, the company which AF keeps is set out in the CHADsVASC table, each point of which has the possible potential to initiate a stroke.

The interesting factor is that the removal of one or more of these conditions does not lower our CHADs score, therefore in the presence of an AF diagnosis, the absent condition (eg hypertension) must still interact with AF to cause the original risk. Hence the belief that 'the company which AF keeps' is a powerful factor in strokes.

[Kaz747 in reply to Finvola]

Yep - My EP said it’s a point for a history of hypertension so even though my BP for a long time now has been sitting around 110/70 I have had periods when it has been unstable (like when my arrhythmias were going crazy and a hypertensive crisis after the birth of my first daughter nearly 30 years ago).

[Lindaj754 in reply to Kaz747]

Thank you so much for all your help

[CDreamer]

I would echo all Finvola said.

My EP was very insistent - for life - as there is little or no evidence that ablation reduces the stroke risk.

[Lindaj754 in reply to CDreamer]

Thanks again

[Dawsonmackay in reply to CDreamer]

I think this point needs further clarification. What I have read is that ablation can be temporary and, if so, then anticoagulants are so necessary. Thus, it is better to stay on anticoagulants than not. There may be cofactors which make it necessary as well but for those that show no other symptoms, have good BP, etc., there is no way of telling if the ablation is permanent. I'd rather be anti-coagulated than worry when the ablation is going to wig out.

[Lindaj754 in reply to Dawsonmackay]

Thank you for this

[doodle68]

Hi Linda you say....

''2 points ,age and sex,''

That will not change with ablation so you will still have the same CHADS score.

Here is a scenario, you have an ablation which appears sucessfull then you develop occasional symptomless AF which increases your likelihood of a stroke (as does your 2 points) having stopped taking an anticoagulant you chance of a stroke is greatly increased .

I have a CHADS score of 3 ,age/sex/previous high blood pressure and have been told should I ever decide to have an ablation I would be well advised to continue taking anticoagulants for the rest of my life.

[Lindaj754 in reply to doodle68]

Thank you. Makes complete sense.