A cautionary tale

[Pindarus]

At short notice I accepted an invitation for a cryo ablation on last Monday. I have been on rivaroxaban and clopidogrel for a year. The ablation was straightforward and successful, however within minutes, while I was still very groggy from the local anaesthetic, I suffered a TIA (very minor stroke) whereby I could neither speak nor formulate words. Obviously the stroke medicos were on site and attended me very quickly and I revived to almost full functionality within 12 hours - the only outcome being that I had difficulty remembering and pronouncing my medications (never easy). The surgeon came to see me the next day and stated that he and his colleagues had never experienced such an event, but having done a bit of research apparently although the risk is low (1 in 200) it is increased a bit in the first 30 days following an ablation.

Although I have absolutely no desire to deter anybody and my procedure does seem to have worked, I wanted to emphasise that you must be absolutely certain that you have taken your anticoagulants up to date and be aware that there is a risk, and you would be wise to have the procedure done somewhere which has full medical backup.

I think it is very important to keep up your blood thinners after an ablation. I did take the opportunity to ask the expert which anticoagulant he felt was best and he stated that he favoured apixaban.

As for the recovery period, I don't think mine is going to be swift, but there is absolutely no pain or irritation and you MUST listen to your body.

[mjames1]

So sorry to hear that and a speedy recovery, but like you say, it may take a little more time. I was put on Eliquis a month before my cryo ablation and told to only hold my morning dose of Eliquis the day of the procedure. I was back on Eliquis that evening and was told to remain on it at least until I see my ep, five weeks after.

Jim

[SeanJax in reply to mjames1]

so sorry to hear about it too. I guessed they did put you heparin during the procedure. The TIA could be from your CVD too and could be a blood clot forming during the cryoablation. Anyway recovery time will be long. Above 70 all procedures are riskier compared to young people especially on people with combined Afib and CVD.

[mjames1 in reply to SeanJax]

Hi. I think this was meant to be directed to the OP, "Pindarus". I def agree with your last sentence!

[BobD Volunteer]

Here in UK most EPs now do the procedure whilst the patient is fully anticoagulated. Back in 2005 when I had my first one stopped five days before and bridged with heparin but by 2008 I remained on warfarin throughout. Whilst full stroke or even TIA is rare , as you say it is still a risk which needs to be protected against.

Glad you aer improving and don't forget to read our fact sheet on recovery.

healthunlocked.com/redirect...

[KMRobbo in reply to BobD]

I was on Pradaxa A/C from 25 days before my Ablation until 4 months after

[Jalia]

Thank you for posting although very sorry to hear of your experience. How frightening for you and your family.I'm on warfarin which wasn't stopped at all for my last ablation.

Wishing you well

[Gumbie_Cat]

I’m so sorry to hear about your experience, but glad they got you sorted and that the ablation has worked. Take it ultra-easy for a while.

[CDreamer]

Excellent advice, Wishing you a full and speedy recovery on both counts.

[OldJane]

thank you for this important update. As you say, a possible risk and best to have experts on hand. Good luck with recovery

[Pindarus in reply to OldJane]

Thanks for your kind thoughts

[secondtry]

Good points, thanks for posting.

[wilsond]

Thank you for posting, and hope you continue to be well. I took up your comment by the EP that he favours Apixaban ,with interest,given that in some areas patients are being arbitrarily stopped to Edoxaban from Apixaban due purely to cost.

Perhaps it might be useful to you to request Apixaban instead?

Enjoy the slightly better weather and rest up well!

[ozziebob in reply to wilsond]

But then what do you make of this German research which gives Edoxaban the best results for strokes and equal best for bleeds? pubmed.ncbi.nlm.nih.gov/347...

Are we wrongly fearful of Edoxaban?

The switching program because of cost reasons certainly muddies the water around any accurate choice of anticoagulant by non-experts like me.

[wilsond in reply to ozziebob]

It is the draconian way some practices are switching patients without conversations,and getting a monetary bonus from NHS to do so which bothers me, as this is a straightforward moeny focusedaction rather than a decision based on medical need.It is reminiscent of the same situation with statins a few years back .

.There is also no antidote/ reversal agent for Edoxaban.

[ozziebob in reply to wilsond]

Good to be reminded of your point about the lack of a particular reversal agent for Edoxaban, although there are procedures in place to treat bleeding if taking Edoxaban.

Perhaps that's why I was recommended Apixaban with my previous history of intra -cranial bleeds.

I wonder how the Germans manage these major bleeds when taking Edoxaban? Same as recommended by NICE?

I will try to find an answer, but if anyone on the Forum knows, I would appreciate feedback.

[ozziebob in reply to wilsond]

I found this in a European Medicines Agency article on Edoxaban ...

"For life-threatening bleeding that cannot be controlled with the measures such as transfusion or haemostasis, the administration of a 4-factor prothrombin complex concentrate (PCC) at 50 IU/kg has been shown to reverse the effects of edoxaban 30 minutes after completing the infusion."

Who knew? I hope the A&E staff, or is it the on-call Haematology staff, are up to speed in an emergency 🤔.

[wilsond in reply to ozziebob]

We can only hope lol!

[Pindarus in reply to wilsond]

Thanks for your kind thoughts

[Guitar335]

thank you for your post. I am on the list to have an ablation and this is great advice

[jeanjeannie50]

That must have been really frightening for you. Looks like your the one in a million that gets a horrible surprise whereas others end up winning the lottery!!!

Wishing you a speedy recovery back to full health.

Jean

[Pindarus in reply to jeanjeannie50]

Thanks for your kind thoughts

[bassets]

I'm very glad you are ok now and convalescing. Best of luck and let us know how you are doing x

[Pindarus in reply to bassets]

Thanks for your kind thoughts

[JOY2THEWORLD49]

Hi

Oh dear what a shock.

I hope you return to more normal.

A friend forgot her PRADAXA 4 days and she had a stroke. Though it was mild she says her memory is not good still.

All the best.

I guess that you were off your anti-coagulant before your abrasion?

cheri JOY

[Pindarus in reply to JOY2THEWORLD49]

No not at all, it was a short notice appointment and I had taken my medication that same morning . Hadn't missed a dose in a year.

[pusillanimous in reply to Pindarus]

Were you told that you should continue taking your anticoagulant for any surgical or dental procedure, whereas the previous advice has always been to stop it for a certain length of time prior to surgery?

[Elizka]

Glad you are doing well. I agree that blood thinners are important and we should take them religiously.