I’m a 66 year old woman, due to have a complete hip replacement in late Feb - have been looking forward to it for months. Always considered myself to be very fit and healthy. However, 8 weeks ago I found myself in A&E with a self-limiting episode of AFib, which lasted maybe 45 mins. I didn’t see a cardiologist just the on call consultant on the medical side, who prescribed Bisoprolol 5mg and Edoxaban 60mg. I was discharged to GP without follow up. GP has arranged an echo (fine apparently) and a 24 hour monitor (NSR throughout) 24 hour BP (fine on the low side but I’d expect/hope for that on Bisoprolol) and I’ve also had a few 12 lead ECGs at the GP - one apparently showed asymptomatic atrial flutter which I was told ‘was nothing’ , the rest were all NSR.
So my question - I’ve gone from looking forward to my hip replacement to being absolutely terrified. I’ve waited so long I don’t want to cancel, especially as I have no adequate pain relief since my AFib as I’m no longer allowed any of the drugs I was prescribed pre-AF. However, I’m so afraid that the surgery will trigger AF and I’m so frightened about the stroke risk. At the same time I’m worried about the bleeding risk from the surgery itself and the spinal. The surgeon has told me to stop edoxaban 5 full days before surgery, but NICE guidelines seem to say only 48 hours. I emailed my surgeon and he’s responded saying 5 days is correct. But that seems a very long time. I’m not sure whether or even how to push this and as I’m not under cardiology I’m not sure where else to turn.
Any experience of this. I feel my life has changed in a heartbeat (or at least in a run of very fast heartbeats!) and without follow up I’m just not sure where to turn.
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TickityBoo
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I’m in the same situation as you are, I am due a knee replacement and I’ve recently developed AFib last October. After reading all the pros and cons I’m seriously thinking about cancelling the procedure. I also would like to hear what other AFib patients know and if anyone has had an operation and what were the outcome.
it’s all a bit rubbish, isn’t it. Having waited so long for the hip replacement can’t believe this curve ball has landed. Are you on any anticoags? What advice have you been given?
Hiya TickityBoo,
I have had a partial knee replacement in Nov 2015. I was on a wide range of drugs including Bisoprolol and Warfarin. My AF is very well controlled - which of course is no guarantee of anything - it is what it is in the moment. I had general anesthetic for my surgery which I think was around 3 hours.
I was told to stop Warfarin 6 days before surgery which I did ... no sweat! No AF during nor afterwards. When I came round I was given two injections of a bridging anticoagulant ( Fragmin) into my tummy area and later in the evening I went back onto my normal dose of Warfarin. No sweat !
TBH it all depends on the amount of pain you are in with your dodgy hip. (or knee for that matter). I ended up being hardly able to walk ..... those were the days when we had a half decent NHS. My pain relief was CoCodomol 30/500 ... the highest grade you can get and is prescription only. If you defer/postpone your surgery when will you get another date ......... 12 months time ??? If it is 12 months how much more pain will you be in by then. Will you end up a housebound cripple. In todays modern, post CoVid, loathsome, useless NHS do you even have a guarantee of a future alternative date.
And all this applies to you too Garden3slids !!
Look, if you have been honest and upfront with your surgeon and anesthetist about your AF, how it behaves, what known triggers are (if any) and your medication its their decision .......... nothing to do with NICE !! NICE are guidlines, anesthetist and surgeon are the practioners who have a wealth of experience. As far as Edoxaban goes I think this is a NOAC which has only been available for a few years (compared to Warfarin of 50 plus years). I wouldn't trust NICE ......... if your surgeon says 5 days, then 5 days it is. Why on earth would you take notice of a mob of nameless, faceless ones at NICE when they aren't responsible for your surgery ?
I might add a hip replacement is a much simpler surgical procedure than a knee replacement.
After surgery I was returned to my room where, as I said, they administered a bridging anticoagulant ( when I'd come round) they also administered special hospital stocks of morphine for pain. Later I continued with my own CoCodomol. I was discharged on 3rd day and sent home. Exercises for my knee started as soon as I was back in my room too.
Anyway, thats my thoughts, you'd be mad to cancel. Go ahead with it - just make sure your surgeon is given all the reports you have, particularly ECG's. Surgery itself will not trigger an AF event.
This may seem a dumb ass question but why are you no longer allowed your meds that were prescibed pre AF ?
If you have any other thoughts and if I can assist I will - just ask. Same for you Garden3slids.
Thanks for the reply. They told me at A&E and my GP agreed that the drugs I had been taking (meloxicam and amitriptyline) can both trigger AF and that as I had had an episode, the risk/benefit ratio of these drugs had shifted for me and I should no longer take them. I’ve been prescribed cocodomol which in the past I’ve tolerated well but on top of the Bisoprolol they seem to tank my BP now. So plain paracetamol it is, which isn’t really touching it. Ipubrofen/Voltorol etc not allowed because of edoxaban.
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I think age may be a factor to consider also , I am over 80 and I’m struggling with this AFib and still haven’t decided whether to go for surgery . The thought of being in a worse health condition really worries me .
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Age is no barrier. You are more likely to trigger AF from prolonged and ongoing intense pain from the worn knee than you are to get AF kick in while under the knife. Pain causes all manner of stress and stress in all its shapes and forms is a known trigger for AF. I was 71 when I had my partial done. Surgeon reckoned it would be ok for 15 years and if needed he could still do a full knee job when I was 86.
Are you under the care of a Cardiologist or an EP by the way, someone who understands and can guide you through your AF journey ?
Don't worry - it is all standard procedure. The likelihood of your throwing a clot in those few days is minimal and the hospital will give you Heparin (or Fragmin or similar) as safe and required.
Hi TickityBoo. I had a hip replacement in February last year. The Anaesthetist seemed completely unfazed that I had AF and I had no problems at all. They have the drugs to deal with it if it kicks off during surgery but he said it was very unlikely.
I stopped Apixaban 5 days pre surgery.
My hip replacement has been a complete success and is a distant memory 👍
I am 66 as well and had a new knee in September last year and I'm going back to Lithuania for the other in March.
I'm on Apixaban and stopped it a couple of days before the op. I dose the next day and back to twice a day as normal after that.
I was only taking paracetamol before my op and like you I couldn't wait.
Please don't cancel. I saw my NHS consultant just before Christmas, having been referred as urgent in November 2021. He knew I'd had one done and when I asked what the waiting time would be for my second on the NHS he said 150 weeks.
No way I could wait that long.
I'm not a doctor, but remember that the pain relief after your op is only for a short while.
My surgery didn't trigger my AF but I did go into it at about the 3 week mark. Mainly I think because I wasn't able to do the amount of exercise I was doing, and a bit of a delayed reaction. I was worried that the stress of flying out on my own would set me off and that I'd get there and have my op cancelled. As it happened I went into an episode at the airport waiting to go - like an idiot I let myself get dehydrated. The slow, painful lurch to the boarding gate got me back.
I'm sure your surgeon has had many patients with this medication so I would listen to him.
hi I am 4 weeks post op THR 78 yrs old. Stopped Edoxaban as per dr and anaesthetist advice. Was given anti coag injections immediately after surgery and for 7 days after then back on Edoxaban The spinal had no affect on my AF. Give yourself plenty of post op rest. All will be fine. Just take their advice. I am getting around on 1 crutch now and live alone so doing most things. Good luck x
Hi TickityBoo , I was 53 and 1 year into my AF journey when I had my unilateral knee replacement . Had it under spinal , stopped anticoagulants 48 hours prior to surgery and no AF issues whatsoever . Try not to worry as this may lead to another episode .
Don't cancel and stop worrying. I have had both hips replaced and had to stop Apixaban both times. The first time was for 8 days but I got bridging jabs of Lovenox. 2nd op was for 3 days no bridging jabs before op but had one after the op before restarting Apixaban. If you bleed a lot during the op they will give you a blood transfusion afterwards. This happened after my second op. No problem. Neither surgery triggered afib and it was just wonderful to walk on my new hips and feel they were strong and stable. I had had afib for much longer and with a heavier burden than you have. You have had one very short afib attack. You might not have another for months or years. But worrying is more likely to bring one on than the op is. Go back to looking forward to it!
I have had a few absolutely essential ops for treatment of cancer and I just had to put all the risk factors to the back of my mind as there was nothing I could do about it. In the event I was absolutely fine each time and Hidden is correct, the team treating you will be very quick to get you back on medication. A hip replacement in her eighties gave my mother her life back, so please don't miss out on this.
You are the only one to make such a decision, but I can tell you my experience and those of my clients (who I treat post-op)...
I have had AFib/Flutter for 13 years, several ablations and a few years ago, despite all I told my clients about "don't do surgeries unless it is your last option..."
I have had an ADR disc replacement in L5-S1 as I had no cartilage on the vertebral plateau of S1. The pain was exceptional and I waited 2 years of intense pain prior to having the surgery. Like you, I had not taken a single NSAID due to Afib.
The only negative was taking the COX2 inhibitors post surgery, which were required (I can explain why if desired) due to the type of disc implanted. This might have played a role in the return of my Afib conditions post ablation. (Three years after the ablation). But one cannot know. I can even accept such due to the joy I have in movement again.
The only question I would ask is if your hip requires NSAIDs or COX2s post op. If so, talk about your Afib meds during that time perhaps?
All my clients were thrilled to have their lives back with new hips! I was as well with my back.
I so hope you can find peace with your choice - beyond that, you deserve to be out of pain.
Hi TickityBoo, I have paroxysmal AF & had a total hip replacement in May 2020 (actually had the op on my 70th birthday - best present ever!) I stopped taking Rivaroxaban 48 hours before the op & the anaesthetist assured me he wasn’t worried so neither should I be. After the op I had a bridging injection & started the Rivaroxaban again the following day, none of it triggered my AF
I wouldn’t cancel the op if I was you, goodness knows how long you will have to wait for another appointment. Trust your surgeon & go for it. The op has changed my life & it could do the same for you
It is usual to be asked to stop anticoagulants prior to an operation. It is usually 3 days so it may be worth your while asking your orthopaedic surgeon to liase with your cardiologist/EP about this it it worries you that much. I have had a Total Knee Replacement on apixaban anticoagulant and was asked to stop for 3 days prior to the operation and was on half dose for a month afterwards - absolutely no problem. The thing with knee replacements according to my orthopaedic surgeon can be the the problems caused by inflammation afterwards holding up recovery and those exercises we have to keep doing to get movement back as we are unable to take anti inflammatories and my consultant wanted to stop the anticoagulants for longer but decided on the half dose afterwards as the best solution. So it doesn't surprise me that now some orthopaedic surgeons might want you to come off anticoagulants for longer. I had a cataract op in December and have my second cataract op at the end of next month and have had to come off anticoagulants for 3 days prior to the operations. No problems at all. I had a hip replacement 12 years ago and my total knee replacement 3 years ago and so glad I did as I would be wheelchair bound by now. The hip op is much easier to recover from than the knee replacement and I speak from experience you just have to do those exercises they give you as often as you can and then again to get your mobility back. Boring I know but it works.
I have just had a Bladder repair and was given spinal block. Apixaban was stopped 2 days before and 3 days after as bleeding expected after op. All went well and no problems.
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Eliquis and hip replacement surgery.
Change to Edoxaban
