I'm slated to have a cryoablation in less than 4 weeks and do not take anti coagulants (AC) because since I had a cardioversion over a year ago I've been almost always in NSR, albeit with lots of ectopics, and my Chad score is 0.
From what I understand I should be on AC for 3-4 weeks before the procedure, yet my instructions do not include any info on AC. I've spoken to the EP's Secretary and my GP surgery asking for clarification, instructions and prescription if necessary, both of whom said they didn't know but would get back to me over a week ago and I've heard nothing, which is about par for the course with the nhs right now!
The info I've found online has been contradictory.
In the meantime I'd be pleased to hear from a few people who've had the procedure. Am I right in thinking I should be on AC in preparation? If so, for how long beforehand?
I'm worried they're going to cancel because I haven't prepared correctly, yet I've done everything I can!
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Mugsy15
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It would be very dangerous to undergo an ablation without anticoagulants IMHO. For all of mine I have been on continuous warfarin and needed weekly INR in range for four weeks prior to the procedure.
Years ago they use to stop five days before and bridge with heparin injections but now at least here in UK A/c is continued to help prevent micro embolii forming during the procedure as these can lead to long term problems. TOE (Trans osphageal echocardiogram) can check for larger clots within the heart but not these microscopic ones which can be formed during the ablation,
You really must get on top of this or you could face having the procedure cancelled.
Thanks Bob, I hoped you'd be one of the respondents.All I can do is to repeat my calls to the EP and GP and be more abrupt; if that doesn't illicit a response then I'm probably snookered.
My conscience will be clear but that's scant consolation.
I'm half expecting cancellation anyway given the way things are currently going in our hospitals.
Mugsy, I really feel for you but the problem is that must of us on the forum are not medically trained which means we cannot advise on medication for reasons I’m sure you will understand. Did you have a pre-procedure assessment with an Arrhythmia Nurse and if so, was this mentioned. Normally they would run through your current medication and advise you accordingly. Try and find out if there is an Arrhythmia Nurse and see if you can make contact. It’s no excuse, but with the combination of the holidays and Covid, communication is more difficult but try and find out if there are email address listed on the Hospital website for the Nurse and the EP and back up the phone calls with an email.
Most of us would already be taking an anticoagulant but hopefully someone in your situation will see this and comment on their experience. However, I would have thought it might be difficult to get a prescription unless it has been requested by your consultant. Hope you get some answers soon…….
Hi Mugsy15, I had a RF ablation in October 2021 and was told by my team it was essential to have an anti-coagulant for 4 weeks prior to the procedure. My understanding is some centres only recommend 3 weeks but you still need to be anti-coagulated or they can’t proceed. This is regardless of whether they do a TOE prior to the ablation as my team did. I was commenced on rivaroxaban and had to be seen in an Anti-coagulation clinic first so they could provide the initial prescription.You also have to be counselled regarding potential side-effects and have blood tests. As the others have recommended you really need to liaise with your team. It would be a pain if it were rescheduled but you don’t want to turn up on the day and it not happen. Good luck making contact with your team.
Thanks for taking the time to reply Dawfor; I saw the guy who will do the procedure and sat with him for a good half hour going through all my questions and having various tests, about 3 months ago. He's a great guy who put me totally at ease, but I assumed that my care plan from then on would include being notified in due course that I was to attend my GP surgery to pick up a prescription and start AC on the appropriate date. I suspect there's an assumption that anyone needing ablation will already be on AC, but there must have been thousands before me who weren't, so this is surely a one-off oversight.
Flapjack, don't be too concerned on my behalf; since my CV I've been fine! Why have I agreed to be ablated then, you may ask. Well, I've had persistent AF and it was horrible in my case. Given that it's progressive I can be pretty sure that it'll be back sooner or later, the EP says I am about as likely as it's possible to be of having a successful procedure, and I'd like to 'mend the roof while the sun is shining'.
If I miss out this time I'll be disappointed but not devastated.
Mugsy, as has been said, it is normal to be put on AC’s for 4 weeks prior to having an ablation for they same reasons they insist you take them for a cardioversion. A cardioversion is commonly carried out during an ablation so unless you have a high bleeding risk it is most likely that you should be taking AC’s before the procedure but it’s not for us to suggest you do it without input from your medics.
Please do everything you can to clarify your position because it would be such a shame if they have to postpone the ablation. Even consider going to the hospital if it’s possible first thing Monday (or even tomorrow if it’s close by), taking your papers and asking the cardiology department to clarify and if, as I expect they prescribe AC’s you will be able to collect them from the hospital pharmacy. Good luck, don’t miss the boat without giving it your best shot!
Thanks mate, I really appreciate the time you've all taken to reply. The Freeman hospital is about 7 miles away, on the other side of Newcastle from my home. I will follow yours and Jean's sound advice if I get no joy from my first two phone calls.
I’m on waiting list at ST Barts for the same procedure and I also have CHADS score of 0
I don’t even have a date for my procedure but 1st thing they done was prescribe me AC’s which need to be takes 4 weeks before and I have mine in the cupboard waiting for the date etc .
Hi - my recent experience - I had a first ablation at Freeman in November and yes I was prescribed Apixaban for 4 weeks prior and was told this was essential. When I saw pre-assessment nurse a few days before, she actually said they had cancelled some procedures in some instances where people had missed doses! I’m still on it until my next scheduled appointment at the Freeman. I found the whole process has been excellent there (albeit I’m still getting breakthroughs). Good luck with yours.
I'm waiting on ablation and been advised I'll need to go (back) on edoxodan 4 weeks prior. As I've had issues with this drug before the EP made it clear that if I couldn't go back on edoxoban then this would prevent the procedure going ahead....so I think its pretty much a prerequisite. Good luck contacting the hospital.
Hi , having been on AC for a year prior to my cryo ablation in 2019 (Chad score 2 due to age and slightly elevated BP) I had a pre procedure consultation at the hospital where I was advised to stop taking my Edoxaban 24 hours before the op. After I came out of the theatre I laid in recovery for 2 hours to let the sedation wear off and was then asked to stand .I bled profusely from the groin and was immediately put on my back and pressure was applied by 2 nurses .Another 2 hours lying flat and we tried again with success and I was sent home with instructions to call 999 if bleeding started again .
I was told I could start my AC again after 24 hours .
Just my own experience but I did wonder if being on AC right up to and immediately following the op I'd be more at risk from a severe bleed but I was fine and the staff at the hospital didn't seem too concerned .
Sounds like they should have used a femstop device to clamp the vein as I and many others have had.. As I explained in my earlier post the anticoagulation is not just about preventing clots forming on the run up to the procedure but also the microscopic ones formed by the action of the catheter. Some years ago it was noted that these could well be the cause of the mental impairment /temporary coginitve decline/brain fog whatever you want to call it seen in some ablation patients hence the continuance of anticoagulation.
Sounds about right right Bob , my immediate thoughts at the time were , how long does an AC stay active in the system .Thinking back I'm sure I was told it stays long enough to still be effective during the procedure .
It would be interesting to hear an opinion from a medical professional as I'm on the list for my second ablation which will be an RF procedure under GA .
Same happened with me but I had to apply my own pressure, half groggy. Ended up going back for a vascular ultrasound a week later as the bruising was horrendous. My entire leg ended up purple, top to toe and 6 weeks of arnica cream to get rid of the bruise.
Wow that's severe ,not an experience to repeat I'm sure.I was fine once I got home that night , just kept a check on the wound site in case I started bleeding when I turned over in bed .
My bruising was pretty colourful to say the least, my wife was shocked but it cleared in under a week .
I still have pain in my groin area when lifting my leg after two years which wasn't there before the procedure and I find that strange considering but my physio thinks some exercises will sort it out
Funnily enough, I had no bruising in the groin, just my nether regions and leg. Sadly, it's a procedure I'm going to have to repeat with possibly a Hybrid thrown in for good measure. Better stock up on the arnica again.
i hope you can get this sorted before your ablation. Like hammerboy I had a bleed after the op and was lucky enough to come round before it got serious, but the nurse on duty applied pressure until it stopped. I took apixaban as normal throughout.
I've spoken to reception at the Freeman who told me Cardiology Outpatients is closed at the weekend; only the Cardio ward is open and it's obviously pointless bothering them.
So I'll keep Monday morning clear and spend it trying to resolve this, applying the suggestions and wisdom I've been grateful to receive here.
I was put on Pradaxa 25 days prior to the ablation. I stopped 4 months after ablation, havibg had a post ablation review. ( that should have been 3 months after).
Just a thought, a bit off piste,, could you get your GP involved? Maybe he /she could get in touch with the EP and do the prescription?Or even just do a prescription anyway?
Well as I said at the 'top of the show', I've spoken to my GP surgery (on the phone and at the reception desk). First the receptionist asked who had advised me that I needed AC in preparation for the procedure. I said no-one, it's just what I understand from my own reading. She said she'd ring the consultant's secretary as a matter of urgency and get it sorted. That was a week ago and I've heard nothing.I have every confidence in the surgical skills of the EP, Dr Murray, but trying to communicate with him or his staff is rather like shouting info the wind. I'm guessing this is what the GP's receptionist has found too.
Let's see what tomorrow brings; I'll let you kind folk know.
I’ve got my third ablation in March at Bristol & have already got my Apixaban ready to start in February - I am like you zero CHAD score very healthy….apart from AF but need to reduce the very real risk of blood clots during ablation. I had cryo balloon some years ago & 2nd was RF - both with Apixaban upfront. Your doctor may do a blood test to check organ function before prescribing. Good luck - we will be recovering at about the same time
….also touch wood apart from a stunning rainbow thigh I have had no bleeds & they now stitch the entry point at Bristol which differed from my 1st ablation but took place on 2nd
Turned up for my first ablation having been on Apaxiban for months.Cardiologist cancelled immediately as he said if anything went wrong he could do nothing to stop bleeding. Had to go on Dagibitran for 4 weeks .
Mugsy15 just clarify this point with cardio secretary and be proactive with GP to get prescription otherwise it falls through the cracks
I had a cardioversion postponed last year as I had missed one single dose of Apixaban in the 3 weeks prior. I'm guessing they would be even more strict with an ablation as they usually have to cardiovert you at the end. I had to come off the AC the day before my ablation and they gave me IV heparin during the procedure. I asked why I didn't just stay on the Apixaban and was told they preferred to control how much AC I received and AC was required as clots could form very quickly on the instruments they used. I'm due another cardioversion on Friday and have made sure that I've not missed any of my tablets this time.
Good luck with getting it sorted and with your ablation.😊.
Turns out the GP was instructed to issue the AC prescription on Friday and nobody has seen fit to tell me. I went straight to the pharmacy and started them as soon as I picked the script up, but it's now only 25 days until the ablation date.
The instructions on the box say to take them for 6 weeks before the procedure!
I've asked the consultant's secretary to tell him I'm concerned and I need to speak to him personally.
She replied that there was no need as he had said starting on Friday would be fine; I said it's not Friday though, it's now 3 days past the date he said it would be fine!
She said she'd speak to him and get back to me, but there's been no further contact today.
Obviously I must go with his opinion if he tells me that in my case 25 days of AC will be enough, but I need to hear him say so.
So whilst some light has been shed on the matter, it's still not fully resolved!
I finally got a call from the secretary, who had raised my concerns with the consultant. He said that 25 days of AC before my ablation will be fine and he has no concerns.
Thinking positively, 25 days of continuous apixiban surely must achieve a good level of anti-coagulation; the negative side of that coin is: if that is the case then why prescribe for 6 weeks?
As ever, I put my trust in the knowledge and experience of someone who knows vastly more about it than me.
Just to update and close this thread, It's now 4 weeks since I had the procedure and I've just taken my last Apixaban. More arrythmia now than before the procedure, so can only pin my hopes on the info fact sheets that say this is common and things will settle in time.
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