Stopping anticoagulation for Left gastric artery embolisation (LGAE) for weight loss trial

[Lyndylan]

I have been invited to take part in the EMBIO trial which involves having a gastric artery embolisation procedure which done by catheter and they say is very similar to other catheter angiogram procedures.

They have said that I should stop taking Rivaroxaban for 10 days or a week before the procedure. I am seeking advice on how risky that is? I have persistent AF that is well controlled with Bisoporol and Flecanide. I last had an episode in October that I was aware of (usually they last for 4-6 hours) but my Apple Watch shows recently that my AF burden is 2% but it has been as high as 8-10%. in the last months.

Here is a link to an article on the trial.medscape.com/viewarticle/96...

I am having huge difficulty losing weight and am also hypothyroid and seeing an Endo soon for that as the levothyroxine prescribed by my GP has had limited impact. So I would really like to take part in this trial but I am worried about the dangers of stopping the anticoagulants. Also when I had a cardio angiogram - I was not required to stop the anticoagulants ( but I was on warfarin at the time and can’t remember if my INR was low).

I’d welcome your comments on this.

[CDreamer]

Just my none medical opinion but stopping 10 days prior to the procedure does seem excessive for a DOAC, 2 days I could understand. I would query the protocols and express your concerns. It could just be that a general protocol was put together to cover all anticoagulants including Warfarin.

[Autumn_Leaves]

Please speak to the people doing the trial and also your cardiologist/cardiology department as this needs a specialist opinion. You could ask one of the trial doctors to discuss this with either your cardiologist or another one in the department. If this is a hospital based trial, they are likely to be in a position to liase and communicate with each other and arrive at a suitable conclusion.

[Lyndylan in reply to Autumn_Leaves]

thanks to you and to CDreamer for you advice. I will definitely question this and have the team at St Mary’s get in touch with the cardio team at Kings

[Auriculaire]

There are many women who find that going on Levothyroxine does not help them to lose the weight they put on during the prediagnosis period. I did not even stop gaining despite my GPs assurance that I would lose weight. The only thing that made a difference was the addition of T3 . Since afib struck that has been stopped and I have gained weight again.. I would query the 10 days especially if no bridging jabs are offered. For my first hip op I was stopped for 8 days but had Lovenox jabs. For the second my cardiologist said 3 days was ample and wrote that in his letter to the anaesthetist.

[Lyndylan in reply to Auriculaire]

yes I will ask for a bridge or a shorter period.

On the weight issue, even my EP has suggested that I may need T3. So I have a private appointment with Dr Paul Jenkins in 10 days after a long wait, hopefully he will give me T3.

[Auriculaire in reply to Lyndylan]

Good luck!

[Desanthony]

It is usual to come off anticoagulants prior to any operation or procedure - I myself have come off for 3 days before a Total Knee Replacement, and cataract operations - my second cataract op is at the end of this month. Though 10 days or a week does seem excessive. I would definitely ask to discuss this with your cardio or EP and the consultant carrying out your procedure.

[frazeej]

If I understand this correctly, you are going to have a procedure to induce a clot in one of your gastric arteries? I would think it to be quite counterproductive to have any amount of any kind of anticoagulant in your system if the goal of the surgery is to manufacture an embolus. This is quite a different procedure from your cardioangiogram!

[Lyndylan]

I don’t think it’s a real clot . It’s a polymer particle that blocks off the production of ghrelin.