A Recurring theme on this Forum - Should I stop my blood thinner after ablation?

[CDreamer]

An interesting article discussing the various studies on is it ‘safe’ to stop anticoagulation after ‘successful’ ablation, past and ongoing, and their limitations on being unable to point to a definitive yes or no answer leaving the writer from BartsAF, Nikhil Ahluwalia • 11 May 2024 to this conclusion:-

It is unsatisfying to not have the data to provide to patients to make this decision. And it feels like we’ve been waiting for this data for a long time. These studies need 1000s of patients to be able to make conclusions about stroke rate and studying this many patients takes time. ndeed, reflecting on this question five years later, we don’t have any strong data to point us one way or the other.

So the conclusion we drew in 2019 remains the same in 2024-

we [doctors] will have to continue to be honest and tell them [patients] that at the moment no-one knows what is correct and to do our best to help them make a decision that they are comfortable with.

I think many of us have been there! Aged 62 after no symptomatic AF, I thought I would be able to stop anticoagulant as I had Chads of 1 (female) and was relatively fit. After much discussion with my EP, who was against but read up on the latest US studies of the time, reluctantly agreed as long as I agreed to restart aged 65 (WHY I thought in my ignorance, would the day I turned 65 be so critical?)

Age 64 - I had a TIA. Thankfully, I recovered within a few days and head scans revealed minimal damage. I couldn’t get back on anticoagulants fast enough! The ONLY possible? factor in my case was that during my ablation it was noticed that I had “an unusually small and oddly shaped” LA and two co-joined pulmonary veins making it very difficult to ensure full coverage during the ablation.

The take away for me is that this is really is not a simple question and I appreciated all of the arguments Ahluwalia makes in their article. Even though my AF burden is less than 2% again now because of the Pacemaker implant in 2018, I am rarely aware of it unless I have an infection when AF can last for 6-8 hours and I become symptomatic, I’m sticking with the A/Cs which I have absolutely no problems taking.

Have a good week-end folks.

[BenHall1]

Thank you CD ........... may the force be with you. 😊

John

[CDreamer in reply to BenHall1]

How are you doing John?

[BenHall1 in reply to CDreamer]

Hi CD,

Goin' good thanks v much. Mrs BenHall1 is my pathfinder ........ she has now firmly retired, shown me the way ... and I have decided to join her and have given my employer a departure date .... 5 July! End of the College year. So much to do around the house, mainly gardens .... subject to my left shoulder behaving itself ( and my heart too ). However, I will miss being "On the Buses" 😊 - its kinda like - Big Toys for Big Boys 😂😂😂

All my meds are behaving but my new Consultant Cardiologist wants me off Nebivolol and onto Sotalol. He also wants me on Flecainide too BUT won't prescribe it until I've had this cardiac CT Scan on 23 May up at Exeter. Meanwhile I'm wandering around with a 7 day Holter Monitor on.

As you might have read, I've ditched Edoxaban and back on Warfarin. So far so good. I have to say it is taking a while to stabilise in the INR target range this time round .... but there is one big factor my BP - it is - the recommendations of my new Cardiac man, cut out booze and get my BP down. This is proving a bit more successful than I expected ......... so far ! I think this cutting out booze maybe affecting the INR. Over the years I've never made too many concessions to Warfarin ......... maybe I should become a BOOZE Artist again. ( Just joking ). Managed to stabilise the BP at the range of 132/70 ish to 137/90. Bit of a way to go yet. As I said to the Cardio man ....................... it's this damn tiredness that gets me ( not drowsiness/sleepiness ) just tiredness, if you get my drift.

Hope you and hubby are staying well.

Best wishes,

John

[Afibflipper]

Hi CDreamer, I am still on them & happy to continue them following 3 ablations - all initially successful but at some point they’ve all become unsuccessful over a combined total of 18+ years. I was only put on them 2 years ago - dread to think that during the previous 16 or more years I’d been at risk of a catastrophic event from clots (could still be) but, I’ve chosen my route to remain on them for my reasons (which my medics agree with) - there is also the risk of bleeding, so after a couple of falls recently I was very worried but come through totally ok.

[BobD Volunteer]

Despite not knowingly had AF since 2008/9 my choice has always been to continue on my warfarin though I may talk to my EP about switching to apixaban next year when I reach 80 (if) as there are views that it is safer over that age than warfarin.

[jeanjeannie50]

People will tire of me saying this but I will again.

Having worked in a nursing home I've seen people who have had strokes, lots can barely move at all, cant walk, swallow anything so have to be fed through a tube in their stomach, can't speak and are doubly incontinent. They look out on the world (if the stroke hasn't taken their sight too) with confused eyes.

To me that's like a living death. So I'll take my anticoagulants without any protest and be grateful that there are such things.

Jean

[BenHall1 in reply to jeanjeannie50]

Jean, I will never tire of you repeating your experience ... never. I haven't experienced any friend or family member close up/nearby/personally with a stroke ......... but my paternal Grandfather had several before he passed away. Strokes and cardiac conditions run in the paternal side of my family ............ the closest I have seen someone ( and I imagine its a pretty close family member of a stroke) is my poor brother in law, who is now receiving end of life care at home from McMillan Nurses .... he was diagnosed a few years ago with vascular dementia.

Too upsetting for words. Just as you describe.

John

[jeanjeannie50 in reply to BenHall1]

I sometimes wish I'd never worked at the nursing home (spent 10 years there), because like you I hadn't had much experience before of many medical conditions, I didn't even have AF at that time.

Once there for a few years I became aware of all that goes on, patients could be walking around one day and dead the next. Families of stroke victims who were fed by tube through their stomachs would sometimes go to the nurses delighted and say I got them to eat so and so (by mouth). What they weren't aware of was that because of having had a stroke their relatives throat muscles didn't work to aid swallowing, that food they'd given them went straight down into their lungs!

I' m proud to say that I worked in the office of a really lovely nursing home. Beds were changed and rooms vacuumed every day and we had no nasty smells. They had lots of entertainment, nice trips out and tasty food. I ate there every lunch time, my boss called me the food taster and I knew I had to report back if I didn't think the food was nice. I must admit it was expensive to stay there though.

Jean

[LaceyLady in reply to jeanjeannie50]

😳 Are the relatives not educated as not to feed them?

[jeanjeannie50 in reply to LaceyLady]

If peoples relatives can see the person is being fed through their stomach, well I can assure you they know there is a reason for that. I have no idea what was said to them as I worked in the office not nursing.

[Oldforge73]

Such a considered, thoughtful and well written post CDreamer. I saw first hand with my mother the devastation that having a stroke can reap on someone because of AFib, recently also my sister, AFib again. I also now have it and the one drug I am happy to take is my DOAC.

[Desanthony]

Thank you CD.