Why anticoagulants for a month before the ablation ?

[Lenlec]

Hi all. I’ve had calls off the hospital asking me to start on abixapan before I have my ablation. I understand the abixapan helps reduce clot risk. But why for 4 weeks or so before and after ? Also I don’t have a date yet for the ablation it could. Be nov or December and don’t want to be in them for six months cheers

[Hidden]

With a fairly heavy AF burden starting at 43, 7 years ago, it is possible you have significant atrial myopathy. This is perhaps a better guide to your risk of stroke than Chads2Vasc2. Some cardiologists would recommend lifelong blood thinners for you now.

[CDreamer]

May I ask why you don’t want to be on anticoagulants? I’ve had no problems at all with Apixaban and been taking it now since 2017.

Back in 2014 I had an ablation after 2 weeks on anticoagulation. I still take them today because the risk of stroke doesn’t always disappear when the AF goes. I think your doctors will also require you to take anticoagulation for up to 12 months after the ablation, even though you may have no more AF.

There is currently a debate on the necessity for anticoagulation for life and as Bill says, the recommendation and decision of whether or not to stay on anticoagulation will depend upon accompanying factors such as atrial myopathy, age and accompanying co-morbidities such as ever having hypertension, diabetes etc.

Some use the phrase - it’s not the AF but the company it keeps which determines risk.

I would suspect your ablation will be refused if you have not been on anticoagulation for at least one month prior and I believe the 4 weeks is the time a clot could lurk in the CV system and the last thing that the EP performing the procedure would want is to disturb an existing clot.

[Lenlec in reply to CDreamer]

I don’t mind taking them for the month before and the period after the ablation just not long term if I can help it. I’m emailing the hospital this morning to see what’s happening. When my ablation comes up will I just get a letter a month or so before or can they contact you a day or a week before ?

[Desanthony in reply to Lenlec]

I only had 10 days warning of my ablation just enough time to get a covid test sorted and get result. Then the ablation was cancelled because there was an outbreak of Covid in the Cardiac Unit. I have been on apixaban for 5 years and have no problems.

[BobD Volunteer]

This is to ensure that no clots are hiding in your heart when the ablation takes place. It is common procedure prior to both ablation and cardioversion as it greatly reduces the risk of stroke during these procedures. Anticoagulants are most of our best friend so not sure what your objection is. You can always stop taking them but you can't undo a stroke.

[Ppiman]

I gather that the fibrillation in the left atrium can cause tiny thrombi to develop and that these can be dangerous. Also, perhaps, the catheter moving along the femoral artery can cause problems?

Steve

[momist in reply to Ppiman]

Steve, have a look at the video from York Cardiology called "Who's the Real Daddy?" youtube.com/watch?v=l_Xc3Fn...(Not working as expected?)

[Ppiman in reply to momist]

Thanks for the link. Dr Gupta is always interesting to watch and listen to. As I listened. I did wonder why he didn’t discuss any links between long term AFib and atrial myopathy. My elderly friend though is approaching 90 and has had persistent afib for very many and remains well.

Steve

[RajaRua in reply to Ppiman]

He's one of the few doctors who has the patients welfare truely at heart. I so wish I could go to see him or afford to have a session with him. As an ex nurse I totally know what he is talking about as regards the medicaliseation of patients. So few doctors have the interest or the curiosity to work with patients and to monitor the ongoing effects of the meds given. As he says it's such 'bad medicine'. I play with the ammounts of meds I'm on especially my BP meds as they are so hard on the kidneys. I love it that he's all for empowering the patient though I'm sure not everyone would want to be empowered to that degree...to decide which drug they should take or not take. I love that he wants to share his knowledge and of course I know he's also benefitting from his youtube channel...

[Lenlec]

Cheers Bob. I’ve had 2 calls of the anti coagulation nurse. But told her I didn’t have any pills too take is it just one a day

[CDreamer in reply to Lenlec]

Apixaban is one tiny tablet taken twice daily - roughly 12 hours apart. You have no food restrictions and it can be taken with or without food.

12 hours is the half life of the active ingredient in your body which means less than half of the active agent will be present in your body after 12 hours. This may vary slightly from person to person, from my understanding, dependant upon how you metabolise the active agent and how quickly or not your Liver and Kidneys clear it from the blood stream.

You would be well advised to have baseline Liver and Kidney blood tests performed prior to starting the Apixaban and to have follow up tests about every 6 months but this should be standard practice by the GP - but just chase them just in case you don’t hear anything.

Hope that helps.

[Physalis in reply to Lenlec]

Twice.

[secondtry]

Good point. According to the latest Dr Sanjay Gupta post on Youtube it could be prudent to be on ACs if you are presenting with Atrial Myopathy. If not the latest thing I read on ACs (sorry forgotten where) was that they are meant to stop more clots forming not dissolve existing ones, which the body can usually deal with if small. Quite understand your concern over ACs, those that think they have no detrimental side effect on the body are highly optimistic IMHO......the big question as always is how toxic will they be and your ability to cope with it, which of course is very individual & relative to the benefit.

[wilsond]

Curious as to your objection to ACsWhat is your anxiety over them?

Ablation is not a permanent'cure'. AF can return without warning and if you are not protected against clot formation you run a very real risk of stroke,which from AF is more fatal than from other strokes

ACs don't thin the blood as many fear they do ,and fear bleeding risks.

Good luck with your proceedure,but you need to be sure to take ACs well before or they won't consider doing it .

Xx

[Lenlec in reply to wilsond]

Thanks.

[Paulbounce]

Hi Len.

A clot can form in your heart. During some medical procedures this can be 'dislodged' and course problems.

Often it's at least 4 to 6 weeks before (for example a CV) before they would go anywhere near you - even if you miss one dose it's a no no. They make your blood less 'sticky' and it's worth doing.

Follow your doc's advice and be ready for your ablation - I wish you all success with it

Paul