How long before ablation to start Edoxaban?

[Outsidethelines]

Morning all. There seems to have been a flurry of recent posts about anticoagulants. And here’s another question from me. Does anyone know how long before my ablation I need to take the Edoxaban I’ve been prescribed? I know some years ago, when preparing for a cardioversion, they said to take the anticoagulant Rivaroxaban for one month prior. But I was younger then, and it was a different drug. What have others been told? Before anyone says it, I will also ask the arrhythmia nurses at the hospital, but you have to leave them an answerphone message and it takes several days to them to reply, so I just thought I’d find out what others have been advised.

[Buzby62]

They would have cancelled mine in December if I hadn’t been on anticoagulant for at least 21 days.

[Outsidethelines in reply to Buzby62]

Thank you, that's very helpful

[BobD Volunteer]

Since nobopdy can tell when the ablation might be offered these days I really would not delay. You need to have been taking it for at least a month prior tothe procedure.

Years ago when warfarin was the only anticoaguant, at a December meeting with my EP he told me waiting list about six months so to start warfarin in March to give plenty of time to get sorted and maybe allow for any cancellations.. In fact ablation happened in May.

[Outsidethelines in reply to BobD]

Thank you Bob, that's very helpful

[mjames1]

Ask the ep. You do not want to be on them one day less than you should be --and you do not want to be on them one day more than you should be. Disregard any advice here to the contrary.

Jim

[Outsidethelines in reply to mjames1]

Thanks Jim. I couldn't agree with you more about not wanting to be on them any longer than necessary, but I'd be interested to hear your reasons for saying that.

[mjames1 in reply to Outsidethelines]

There's a reason for risk assessment before you take thinners. If you fall into the category where you do not need to take thinners, then the bleed risk outweighs any stroke prevention benefits.

So if you're solely taking thinners because you have a scheduled ablation, taking them any longer than necessary puts you at additional risk without any medical benefits.

Jim

[Outsidethelines in reply to mjames1]

Thanks Jim

[bean_counter27 in reply to mjames1]

"taking them any longer than necessary puts you at additional risk without any medical benefits"

Jim

I know what you mean and agree 100% with your intent but just to clarify it (hopefully) for others.

A CHA2DS2-VASc score of 0 doesn't mean zero stroke risk. It only means they have a "lower" stroke risk than other people with AF. Even though they are lower risk, they might realise a medical benefit from taking AC (reduced stroke risk/impact). However, for someone with a CHA2DS2-VASc score of 0, the risks from taking AC are likely to outweigh any benefits.

[mjames1 in reply to bean_counter27]

"Benefit" means to have an advantage. There is no advantage to take a thinner if your score is a zero. Therefore, there is no benefit.

Jim

[bean_counter27 in reply to mjames1]

Does taking AC when score is zero still reduce the person's stroke risk? Yes, it does. Is that a benefit?

I understand what you really mean - the risks exceed the potential benefits for person with zero score.

But it is misleading to say there is no potential medical benefit from taking AC if your score is zero. It is a medical benefit if you avoid an Ischaemic stroke. Yes, it is accompanied with the risk of a major bleed, which may or may not occur. The uncertainty of the latter results in some people with a zero score still electing to take AC. Why would they do that - and why would their doctor give them the script - if there was no medical benefit from them taking AC?

[Jonathan_C]

The smartest advice given to you is to speak to your EP. And my advice is to ask that person to clarify the difference between blood thinners and anticoagulants and the respective risks of taking v not taking.

[Outsidethelines in reply to Jonathan_C]

Thanks Jonathan. I’m an NHS patient so I don’t have a way of speaking directly with my EP, but I do intend to ring the arrhythmia team, as this seems to be the way they like it.

[Desanthony in reply to Outsidethelines]

You can call your EP's secretary if necessary and as them to clarify the situation via the EP.

[CDreamer]

I was told 14 days prior to ablation with the DOACs - but that was back in 2014. I was told I had to have at least 12 months with no AF before I stopped following ablation.

Wafarin of course is about being within range so not always about time taking them.

Calculating and Assessing the stroke v bleed risk is not very reliable and really comes down to which you and your doctor fear most - stroke or bleed? I stopped following 12 months free of AF, as far as I was aware, then had a TIA a few months later.

There does not seem to be much consensus on how long after ablation you could stop but 12 months seems the minimum and I accepted that I am on them for life, thankfully I have no known side effects. I would also mention that the view in Europe about anticoagulants seems to differ from the view in US.

[OldJane]

my EP would insist on complete coverage - not missing even one day - for a month minimum

[Outsidethelines in reply to OldJane]

Thank you Jane

[Jajarunner]

I was told 2-4 weeks but you must talk to your arrhythmia nurses as it may vary.x

[Outsidethelines in reply to Jajarunner]

Thank you. I will leave them a message today

[Tapanac]

I was put on anticoagulants for about 6 weeks before my ablation and which was almost immediately that my afib/tachycardia was diagnosed. I assume you’re ablation is because you have afib or Aflutter so I’m surprised you aren’t on anticoagulants already to lessen the risk of a stroke.

Despite what is written sometimes anticoagulants are not blood thinners

Many years ago I was on rivaroxaban but they gave me UTIs so was switched to eliquis apixaban which my EP said was kinder to stomach and brain and also has an antidote

Good luck with your ablation

[Outsidethelines in reply to Tapanac]

Thank you. I was on Rivaroxaban for just a month and it gave me lower leg swelling, which I’d never had before that. The one they want me to take now is Edoxaban. I wonder what lovely side effects that one will have

[Tapanac in reply to Outsidethelines]

Edoxaban is cheaper so they always try thst first. If you can try to opt for apixaban (eliquis manufacturer)

Good luck

[mhoam in reply to Tapanac]

Hi Tapanac,

Edoxaban was cheaper than Apixaban while they were still under patent. I doubt that is still the case now there are generic versions of Apixaban.

I have had a number of prescriptions fulfilled by generic versions of Apixaban without any issues.

[Buzby62 in reply to mhoam]

My reply on another post healthunlocked.com/afassoci...

Up until a year or so ago, Apixaban was only available in its branded form of Eliquis which apparently was/is expensive in comparison to Edoxaban. There were quite a few posts here at the time that patients were being asked or some even said persuaded to change. Then came the generic unbranded versions of Apixaban and I’ve not heard much more about it since. I’ve been on Apixaban for 3 years but the last year or so have not received branded Eliquis once, just generic versions.

Have a look at some of the Related posts on the right of the page (bottom on mobile) or do a search to see previous posts.

[Slidingdoors99]

Hi! I had my ablation on October 24th and was told not to stop my Edoxaban! I got up very early in the morning to take all my heart tablets because I was due to come in for my ablation at 10:30am.

[Desanthony]

As far as I am aware you still have to be on them for a month. This was still true in 2022.

[Krissy55]

My ablation is Feb 28 and I had to start mine in Jan 28 . Two a day to prepare for surgery. The EP also has asked me to start another medication 5 days prior .

[KentAndrew]

I was prescribed Apixaban (later changed to Edoxaban) on the day my AFib was discovered and had been taking them for nearly a year prior to my Ablation.

I was specifically asked to state and sign that I had not missed a dose for the whole month before the procedure.