No Afib Episodes Then Why Take Blood Thinners

[willec49]

I have a friend who had a cyro ablation in February. He was on amiodarone for a time but then was taken off and has had no Afib now for months. His doctor is offering him a Watchman ( left atrial appendage closure) procedure to eliminate the risk of blood clots. My question is: If a person's cyro ablation was successful and he has had no further Afib episodes which are supposedly the cause of the formation of blood clots, why would they need to be taking blood thinners? Thank you.

[CDreamer]

Good question with complex answers which are individual.

It really depends on your CHADSVaSC score as it’s thought that the stroke risk continues, even after the AF ends - that is certainly what happened to me. I pushed to discontinue anticoagulants after 12 months AF free, had a TIA about 6 months later so couldn’t get back onto the A/Cs quick enough.

[willec49 in reply to CDreamer]

Thanks for your reply. Yes, I know about the CHADSVaSC score. I'm sorry to hear you had the TIA and hope you recovered completely and quickly. So, if Afib can cause blood clots, what then is the probably cause if you are NOT in Afib? Does the fact that you were in Afib in the past permanently alter something so that you are permanently susceptible and another factor can cause a stroke?

[CDreamer in reply to willec49]

The saying goes - it’s not the AF but the company it keeps. Nothing is proven yet.

[willec49]

My CHADSVaSC score is 2, having some arthrosclerosis and being 73 years old. My Cardiologist had me on low dose aspirin for years, saying I didn't need a blood thinner. Then, since my EP insisted I go on Pradaxa before my cyro ablation in March, I've been on it ever since.

[Hidden in reply to willec49]

EP’s probably have a much better understanding of the risks associated with AF than many cardiologists. Bearing in mind how many people have asymptomatic AF and don’t know it, even after a “successful” ablation, AF can occur and because the symptoms are often milder, so it’s really up to you if you want to expose yourself to the risk of having a stroke……

[willec49 in reply to Hidden]

Thank you for your reply and insight. These responses answer my question. I wondered if anyone whose ablation worked were told by their EP's or cardiologists that they could stop all medications and blood thinners. I've heard cases where the meds were eliminated but wondered about the blood thinners.

[Hidden in reply to willec49]

After the first review, patients are often advised to stop taking their rhythm/rate medication. The consequences of do this are generally not life changing if it all goes wrong, you just start taking them again. Sadly the same cannot be said of anticoagulants……

[BobD Volunteer]

It is very important to be anticoagauilated prior to ablaation as teh process itself can create small thrombii which can cause strokes. As has been stated by others above there is no current study which proves that successful ablation removes stroke risk, hence most of us are anticoagaulated for life. You will see countless posts from people in your situation who are worrried that they have to stop their anticoagulant for a short period for some other surgical procedure .

As the old saying goes, you can always stop taking an anticoagulant but you can never undo a stroke.

[willec49 in reply to BobD]

Thanks for your post. Yes, I learned this and am faithfully taking the Pradaxa. I did have to stop it for two days preceeding a minor surgery last week. I know what you mean here.

[Pedroboy]

With the increase of blood clot post c vax., maybe having a thinner would be good thing to have.

[MarkS]

It is not so much a question of AF causing strokes, as both AF and strokes having a common underlying cause which is inflammation. The inflammation causes changes to the inside of the heart wall which result in AF. An ablation simply blocks the rogue impulses but does not alter the inflammation or the changes to the heart wall. Ablation is not a cure for AF, it treats the symptoms.

Consequently you are still at risk of stroke after a successful ablation. Having said that, I think that ablations do reduce the risk of a stroke slightly due to the more efficient beating of the heart.

However, you might look at the underlying cause of your inflammation. It could be due to gum disease, too much weight, smoking, poor diet, too much alcohol, anxiety, too little exercise or too much. In my case I think it was the latter - too much exercise. I have moderated that and feel better for it. I have also had a successful ablation 12 years ago and still take my warfarin religiously.

[willec49 in reply to MarkS]

I appreciate your taking the time to respond to my post and am happy to hear that you are doing well. As I wrote to oscarfox49 below, when I was diagnosed with Afib about four years ago, I was awakened to the denial that had allowed me to carry excess weight and unnecessary stress so I immediately dropped 55 pounds and have kept it off for the most part. And, I'm not fooling around with the blood thinners either as I obediently take my Pradaxa every day. I just had these questions about the relationship between having an irregular heart rhythm or not and its relationship to the stroke risk. All the best to you.

[Jonathan_C in reply to MarkS]

Is the line of causality Afib causes inflammation or inflammation causes afib?

[secondtry in reply to MarkS]

Well Mark congratulations that is the clearest and most likely answer on the question I think I have ever read here! In line with many more of your replies I've seen.

[whats in reply to MarkS]

Is inflammation is basically swelling caused by injury, like you can see on your skin? (I have lupus and have been hearing that word blamed for everything until its just a blurry concept). I get how too much exercise and the other stuff you listed can cause inflammation, but how does too little exercise cause inflammation? Seems like it mostly causes unfitness? Also it was my understanding that clots form in the left atrial appendage and in other places in the body, and can lodge there for months (doctors can see them on scans), and sometimes break loose and cause ischemic blockages, strokes or TIs if the brain. The presence of these stationary clots is predictive of strokes. I guess inflammation and AF can both cause clots. I don't know what makes clots eventually dissolve harmlessly, but I'd think ACs would help? I guess clots are isolated from the blood supply. In people with AF, the total AF burden, that is the % of time a person is in AF is related to the number of clots found on scans and to stroke risk. Its just expensive and maybe unhealthy to scan everybody for hidden clots and maybe the technology isn't available everywhere.

[oscarfox49]

Take it from someone who had a totally unexpected stroke two years ago, you do not KNOW when you are in AF and just because the operation appears successful or a drug treatment is doing its stuff, AF can start and finish in a space of half a minute. That can be time enough for a clot to form under certain circumstances and find its way to your brain! If the anticoagulant is not doing any measurable harm the risk factor far outweighs NOT taking it. A stroke is for life; it is not something you just shake off and recover from, unless you are more fortunate than the vast majority of those affected.

[willec49 in reply to oscarfox49]

Thank you for your experience and wisdom. I'm sorry you had that unfortunate experience and hope you have recovered. Yes, I am faithfully taking my Pradaxa twice daily as prescribed. I'm not fooling around with this situation. As soon as I was diagnosed with Afib about four years ago, it shattered my denial and I dropped 55 lbs. which I have mostly kept off. I realize the alternatives to not caring for ourselves is not pretty. All the best to you.

[Jonathan_C in reply to oscarfox49]

if you are going to pay attention to only one reply on this thread, make sure it is this one.

[Ppiman]

I've read that it's because doctors aren't sure whether it's the AF itself that is causing the micro-thrombi to form in the atrial chambers or some other reason. There's clear evidence, for example, that certain shaped appendages ("cauliflower shaped" for example) increase the risk of thrombus formation greatly when compared with other shapes.

Steve

[dwright12]

I was on blood thinners for aflutters and had an ablation. I stopped the blood thinners per my doctor and a couple of years later developed afib and back on blood thinners! Had the watchman implanted and waiting to go off blood thinners in November.

[willec49 in reply to dwright12]

It sounds like you have an attentive doctor, providing an ablation for your flutters but some here would disagree with him taking you off blood thinners. It doesn't sound like you had a stroke or anything like that. Could that be because flutters, in themselves, aren't considered true Afib? Good luck with the Watchman and I'll be very interested to hear how things go for you.

[dwright12 in reply to willec49]

I had to wait 6 months after ablation for flutters to get off blood thinners per my doctors

[willec49 in reply to dwright12]

But he DID take you off of them which indicates that perhaps flutters aren't considered full on Afib. BTW, did the ablation stop your flutters?

[dwright12 in reply to willec49]

The ablation stopped the aflutters. I was diagnosed with afib 5 years later.

[riffjack846]

Why? If you've ever had afib EVER...there is a pretty good chance that a blood thinner will save your life in the future. See CDreamers post below, same thing happened to me.

[Afibflipper]

you don’t always feel AF and if paroxysmal may not be caught on short time ECG. As many of us know ablation is not always a cure and it can come back at any time.

As others say, hidden inflammation, sclerosis, TIA, fatty plaque deposits and so on - is it worth the risk?

[willec49]

Thanks for your reply. I appreciate your perspective and have learned much on this site.