Stopping Rivaroxaban after ablation

[Dawfor]

Hi all. Just spoke to the Arrythmia nurse to clarify when I should stop taking the rivaroxaban post ablation. She told me 4 weeks after was fine even though their initial referral letter to my GP said 6 weeks. She said she spoke to the Consultant who assisted at the procedure and he’s happy with 4 weeks although if I felt safer (I do) I could stay on it for 6. She did apologise for the conflicting advice regarding this and that I was told to stay on my other meds for 3 months post-ablation (by one Consultant)and that I could stop them straightaway if I wanted to by another Consultant! It all feels a little frustrating and also worrying that I had to clarify as I don’t know if everyone would have the means to contact their teams to ask what feels like really important questions. I also don’t have any follow up until July 2022 as they do not have any appointments before them. I am very grateful that I had the procedure and all feels good so far but it does feel like you are left on your own a little after something which feels so significant.

[Hidden]

Hi, I know what you mean, I was told I could stop my Apixaban and Bisoprolol 3 months after my ablation but then looking at some posts on this site, people have been told to carry on especially the anticoagulants.I had an episode a few weeks ago and ended up in A&E, the Cardiologist told me to go back on the Bisoprolol until he speaks to my EP.

I guess I'll have to chase it up myself!

Hope you get it sorted! X

[Dawfor in reply to Hidden]

Hi Rhea78. Thanks for that and sorry to hear you’re having trouble again. Hope you get some answers soon. Like you, I’ve read the posts on anticoagulation after ablation and there seems to be a variety of protocols. Two months minimum does seem to be the consensus so 4 weeks does’t seem long enough for me. The Arrythmia nurse said my stroke risk was low (Chadsvasc 1) but I think she meant pre-ablation. My understanding is that we are anti-coagulated after ablation both because there is often a recurrence of AF and because we are a higher risk of clots due to the damage caused to the tissues by the ablation process itself. I asked her if the fact that I apparently had extensive RF ablations for both AF and flutter would effect the duration of the anti-coagulation and she just said the Consultant was there and he was happy for me to stop it. I guess we just have to trust that out team know best but it would be more reassuring if they were all following the same guidelines.

[Bowcat in reply to Dawfor]

I guess everyone's case is different.I've had 2 Ablations, had the 2nd one about 18 months ago. I wanted to stop taking Rivaroxaban but the EP told me that I should take it for life! So much conflicting news.

[Dawfor in reply to Bowcat]

There certainly is! And, as you say, we are all different and, our doctors have their own preferred way of doing things.

[Honeywine in reply to Hidden]

Hello my heart reset did not work out so I still have af, I was on warfarin for about 2 years or so, because of problems with warfarin meds and having to go for blood test every week or 10 days , I was put on 20 mg of Rivaroxaban, which means I'm on it for life, so now I'm an easy bruiser and bleeder,

[CDreamer]

My EP wouldn’t entertain me coming off Anticoagulants after ablation. I pushed & he did some research & found what he thought a reasonable study on coming off anticoagulants after ablation after 12 months with absolute proof there was no AF. This we did - another year on I had a TIA. At that time my risk factor was 1 for being female.

Just saying.

Doctors have different opinions (and they are only opinions & judgements) I’ve found US advice very different from UK especially re anticoagulants.

[Dawfor in reply to CDreamer]

Hi CDreamer I hope you made a full recovery after your TIA. I imagine it was pretty scary at the time.It is interesting how differently they do things, especially when everything is supposed to be evidence based.Can I just ask if you were in persistent AF when you had your ablation? I was wondering if the type of AF influences their decision making regarding anticoagulation as I have (hopefully had!) PAF. Maybe because of that I’m considered to be lower risk. I’m also interested in how they determined “no AF”as the Arrythmia nurse told me yesterday they don’t do any sort of monitoring after ablation . I have read that ablation can make episodes less symptomatic so presumably more are missed .

[CDreamer in reply to Dawfor]

I was Paroxysmal & yes when AF returned 12 months after the TIA it was less symptomatic for a while. Thinking here is that just because your AF has been treated & you may not be aware of any AF, the stroke risk remains therefore anticoagulants for life but obviously it’s an individual’s choice and many won’t accept that idea. I absolutely agree with your last sentence. 👍

I also think that there has been so much adverse publicity through class actions in the US against companies it has influenced doctors opinions so that they are scared of litigation. There is obviously some risk in taking anticoagulants as well. It’s how you balance those risks and generally people don’t know how to assess risk. No one wants to take unnecessary medication that may do more harm than good.

Just a thought….. I wonder how many doctors have been sued for NOT advising anticoagulants for AFers?

[Dawfor in reply to CDreamer]

I did wonder if potential litigation may affect decision making. And an interesting question about not advising anticoagulation! I guess they have to do what they believe to be in the best interests of their patients and weigh up the pros of decreasing stroke risk against the bleeding risk. I think it would be really helpful to be part of that decisions making process for myself but it seems that unless,as you did, you push ,it just doesn’t happen.

[Bennera513]

Yea, I identify with your statement,..."we are left a little fending for ourselves". At my EP's practice, they have me confer with a physicians assistant before ablation and after in follow-up. I have only seen the EP the day of the procedure itself. I don't get to see him again until after the blanking period. I understand the reasons.

However, he had mentioned I'd be on Apixiban for 2 months, whereas the assistant said I had to go 3 months. I surmised she was following a standard blueprint. I ended up contacting the EP directly and he was fine with me coming off after 2 months. This made me happy as I have ski plans in the near term and this represents the last medication that I am currently taking.

I read something recently from someone in a similar situation who said their EP said they didn't want to see the patient for 3 months, that they were under a blanket and healing. Though, it seems everyone should be able to clarify and adjust medications accordingly through reasonable access, if not gain some reassurance and peace of mind as needed...?

[Dawfor in reply to Bennera513]

It is a bit confusing when you and told different things and good you were able to clarify with the EP directly. My follow up will be nine months post-ablation but I can contact the nurses if needed meantime which is reassuring.