Hernia operation with permanent AF and apixaban as blood thinner. How can I minimise the dangers?

[oscarfox49]

Has anybody else with permanent AF and who is on apixaban or similar faced treatment for an inguinal hernia as I have a number of serious concerns?

I had a right sided hernia over a decade over when I was just taking aspirin and had mild paroxysmal AF, so I stopped the aspirin for the op which was of course carried out with a epidural local anaesthetic injected into the spine.

Now at 77 I have recently developed a similar left hand inguinal hernia which will need treatment but I am concerned about the following:

1. Taking apixaban raises the risk considerably of bleeding into the spinal cord with a local anaesthetic which could cause paralysis.

2. Stopping apixaban several days before the operation however increases the risk of another stroke (I had one four years ago) especially perhaps under the stress of an operation as I am prone to enormous anxiety.

3. If I opt for a general anaesthetic, with permanent AF this too could be a high risk as I read that this is far more onerous on our physical system anyway. Also I am sure I would be told to stop the apixaban before the operation too with the consequent increased risk of stroke.

I haven't discussed this with my doctor yet, as my GP tends to be very unsympathetic and just says, 'Just go ahead. Life is full of risk. And at nearly 78 you shouldn't complain about the risk!'

What have been the experiences of other faced with this kind of dilemma?

[Mrsvemb]

You should take advice from both your cardiologist and the surgeon doing the hernia procedure.

I have just had heart surgery and I was only asked to stop 48hours before. I take dabigatran which is twice a day, the same as Apixaban. As it is twice a day the half life is 12 hours, so should be perfectly safe.

I can only tell you of my experience, but you should be guided by the surgeon and/or cardiologist, not your GP.

[oscarfox49 in reply to Mrsvemb]

Thanks. That is helpful. It is important of course to make sure we have a good cardiologist as the last one I saw locally was appalling, abusive and totally unhelpful. If it was him I would have no confidence at all!

[Auriculaire in reply to oscarfox49]

You could ask for bridging injections of Lovenox to allay your fears about stroke. I was taken off Apixaban by an over cautious anaesthetist for 8 days before my first hip op and the nurse came twice a day go give them. My cardiologist said this was over the top and 3 days off was ample and wrote to that effect in his report before the 2nd hip op. You could mention your fears about stroke to the anaesthetist when you have your pre op consultation. Personally I would always opt for a GA but I am lucky and recover quickly afterwards with no nausea .

[Rambler398]

At age 72, I had an elective repair of inguinal hernia under GA as a day case. I was told to stop Apixaban (permanent AFib) 3 days before.

I asked about regional anaesthesia but the surgeon was reluctant to consider that.

I would be happy to have a repeat on the same basis. I’m not convinced that a relatively short and (presumably) light GA for hernia repair, even in AFib is particularly high risk.

Maybe consider letting your surgeon know about your anxieties. In view of your history of ischaemic stroke, he may say that stopping for 2 days would be sufficient.

[oscarfox49]

Interesting that here (France) the local (epidural) anaesthetic is the 'norm'. They would not normally ever consider a GA unless there was a special reason. Your reassurance about the GA being light is reassuring though. I think I must discuss it with an anaesthetist.

[Desanthony in reply to oscarfox49]

I had a sedation and epidural for my last hernia - like you i have had 2 and had no problems with stopping the apixaban before the operation. Though I have not had a stroke previously. It is best to discuss these concerns with the surgeon and anaesthetist doing the operation. I have had most of my operations with sedation and local over the last 20 years as I don't get on with general at all. though did have one with a light general - in by 6 operation over by 7.30 and eating a lovely breakfast at 8 home that afternoon and things were fine.

[Tapanac]

what a horrible doctor. I think I would try to see a different one.

I know your situation is different but during my time of taking spixaban I have had to stop it for up to 3 weeks at a time snd still here to tell the tale 🤞🤞

Coujd you try to speak with or your cardiologist or EP or the surgeon who is carrying out your operation as he wouldn’t want to take any chances either way

All the best to you

Xx

[oscarfox49 in reply to Tapanac]

Thanks for the good advice. I must admit the unfriendly doctor and cardiologist (some time ago now just after my stroke) was very different to my normal experiences in French medicine and I just had bad luck in seeing one of the few poor doctors. Most people I have encountered here have been very understanding and full of care and I hope I will get similarly good people when I have to have the hernia operation.

[Tapanac in reply to oscarfox49]

I do hope all goes well for you xx

[bantam12]

5 weeks ago I had major surgery which turned out to be very complicated and challenging for the surgeon. I had an epidural plus general anaesthetic, because of my heart issues the anaesthetist assured me he would use the safest meds and I would be very closely monitored during and after the op.

I stopped my Apixaban 48 hours before op, had an anticoagulant injection day after op then back on my usual Apixaban dose.

I’ve had several ops and procedures since taking Apixaban and never had any problems with stopping and starting it. However it is normal to be concerned so make your Drs aware that you are worried and need reassurance.

Good luck

[oscarfox49 in reply to bantam12]

Thanks. That is reassuring. I hope you are recovering well now from your surgery and I am pleased you had a thoughtful and considerate anaesthetist. I will have to make sure I make my concerns known both to the cardiologist and the anaesthetist when I find out when they will operate. I think it is the stroke that worries me most as the one I had four years ago was so totally unexpected when I thought I was in good health and very active, and I worry about the stress of any operation and the effects it might have on my AF especially if I am deprived of apixaban at the time. I am sure they will be able to reassure me about that when I discuss it with them.

[Ilovedogs12]

I have no similar experience so cannot help with your query, but I would like to say you should consider changing your doctor! They're not just being unsympathetic. If he/she has that attitude how can you trust them to give you the best care in any situation?

I hope all goes well for you.

[Qualipop]

I can't help about your meds but I can say if you are having a hernia repair, make sure you look up "Side effects of polypropylene mesh " beforehand. Thousands of people have had horrible problems caused by it . Most will be womens' problems but the same applies when it's used to repair a hernia. If possible ask for the repair to be done using your own body tissue.

[oscarfox49 in reply to Qualipop]

Thankfully I have had no problems from the mesh repair I had done on my right side about 16 years ago. I have often wondered about this hearing the problems experienced with women but wife assured me it was different in women as the bits being repaired are more complicated in shape and orientation (and use). The abdominal muscles are mainly flat. I keep telling myself this should be true, but like you, it has caused me some concern and I have not read anything about the problems in men. Thanks for alerting me.

[Qualipop in reply to oscarfox49]

IT is however the same mesh or tape or whatever they call it, no matter where it's used and it goes hard. I'm really pleased you've had no problems. IT has been banned for some procedures but not all and hernia repair is still allowed. There's more written about women's problems than men because of where it is and the damage it causes and it's obviously reported far more.

[kocoach]

Hello oscarfox49; I had a hernia operation at age 71 and before the Dr. started the operation he said I went into afib, so they had to wait until I went back to NSR, about an hour he said. I don't know if it went back on its own or if they gave me something intravenously, at any rate everything turned out good. Good Luck with your hernia repair. PS; The Drs know how to handle just about every situation that may pop up. I've had afib for just about 38 years now and was on apixaban at the time, no problems, in fact had a heart attack the very next day, luckily I was still in the Hospital.

[Treetopp]

Must admit that as I have a femoural hernia I too am concerned about any op needed. especially as I am on Bisoprolol Fumarate which I think lowers blood pressure. Have had two inguinal hernia ops but long ago before heart problem. Wish you well and speedy recovery.

[oscarfox49 in reply to Treetopp]

Thanks for your best wishes. I hope you can sort your hernia problem too without any problems. Any operation is of course a concern given our existing AF conditions but I am hoping that they know what they are doing in making allowances for our state of health and finding ways to minimise risks.

Best wishes