Edoxaban forever?

[JoDogBlue]

I've been on edoxaban and bisoprolol after permanent AF became part of my life in 2022. I had an ablation in April this year, but went back in AF soon after so had a cardioversion and amiodarone for two months. I'm still in NSR, feeling better but still tired and get breathless fairly easily.At my follow up last week the consultant suggested I try stopping bisprolol to see if my energy levels improve. He also said it was too early to say if the ablation was a success as I'll still have amiodarone in my system.

I turned 65 in April and he said I should remain on edoxaban based on my new CHADS-VASC score of 2 (I have well controlled hypertension).

I didn't ask if that means I should stay on edoxaban forever in case AF returns, I'm guessing it does but wonder what others have done/ been advised?

[BobD Volunteer]

There is little or no evidence that even successful ablation removes stroke risk where AF is concerened so short answer is yes. Anticoagulation for life if your Chads2vasc2 score dictates such. As I'm sure you will have been told, once given a score can't be removed, so your hypertension still counts even if well controlled.

I haven't had AF since 2008 but will never stop taking warfarin which I have been on since 2004.

[Sixtychick in reply to BobD]

Good to know you’ve been AFib free since 2008 Bob. Hope my ablation keeps the nasty AFib away.!!

[Rainfern]

Yes, anticoagulants for life is the norm. I look on the positive side and feel protected from stroke and try not to fall off my bike.

[Cavalierrubie]

Yes, l have in my medical notes “for life”. I would not feel safe without an anticoagulant, in fact l would be scared out of my wits. Don’t come off the bisoprolol too quickly if you have been on them for a long time. Have they given you an alternative? Hope your ablation is a success.

[JoDogBlue in reply to Cavalierrubie]

Thanks for responding. No mention of reducing the bisoprolol dose just trying without them for a couple of weeks and monitoring my blood pressure..

[Cavalierrubie in reply to JoDogBlue]

No, reducing the dose wasn’t mentioned in your post, so l was not referring to that. I didn’t think you could stop bisoprolol abruptly as it can cause a reaction in some. You have to do what dr. said.

[Auriculaire in reply to JoDogBlue]

Some people can stop Bisoprolol abruptly. Others need to wean off- some very slowly to avoid withdrawal symptoms like palpitations and feeling jittery. You do not know which category you fall into till you try. To be on the safe side consider weaning off. To do this you reduce the dose slowly leaving at least a week and preferably longer between reductions.

[mjames1]

In the United States, the ep's are split, with many of them letting us off thinners after a successful ablation, based on some promising data from pilot studies. The ongoing REACT-AF trial is further testing this premise and others, including PIP (as needed) anticoagulation for CHADS 1-4.

Jim

[sunlovah in reply to mjames1]

When will the trials finish and results be out, do you know?

[mjames1 in reply to sunlovah]

Estimated completion date is 7/2029. However, preliminary results are often available earlier, especially if there are significant findings one way or the other.

Jim

[BenHall1]

Hi,

I was diagnosed .... with paroxysmal AF in Jan 2010 ( aged 65 ) ........ the Cardiac Consultant prescribed Warfarin for life ( among other drugs ). So what - if it keeps me stroke free ! I had a 4 to 6 month excursion with Edoxaban but wasn't prepared to accept the side effects - back to Warfarin, quite happily.

[108cat in reply to BenHall1]

May I ask what side effects you experienced on Edoxaban? I've been on it for a while and seem to be getting more headaches (mild not horrendous), vivid dreams, breathlessness .. and wonder if it's Edoxaban.

I hadn't heard there are less side effects with Warfarin?

Cat

[BenHall1 in reply to 108cat]

Hiya Cat,

Started off as mild dreams, frequent ones. Over time these worked up to the most vile, ghastly nightmares you could ever endure ........... and the loss of sleep .... don't go there !

My GP had been trying to get me off Warfarin for ages and I kept resisting ! As it happened I had to be prescribed another medication for another medical issue and was told by my GP that it was more effective if I took it with Edoxaban. So I gave it a go.

But after my experiences I phoned her (my GP ), explained my problem and told her - in no uncertain terms - I was gonna stay on Warfarin. I also made it quite clear I was not going to take any of the other NOAC's. Been on Warfarin ... trouble free, ever since. She had no choice but to agree.

For me, Warfarin is my best wonder mate.

John

[Bismark in reply to BenHall1]

I'm 67 and had AF for over 15 years where I was on Flecainide and Digoxin and Apalis a lot later on. I had an Ablation just over a year ago because I had to have 2 Cardio inversions. After the Ablation my heart specialist said that if everything went well when I was off my Flecainide and Digoxin then I would be able to go off Edoxaban/Apalias. So according to my heart specialist I can go off Edoxaban if the Ablation is successful.

[108cat in reply to BenHall1]

Thanks John this is good to know ...

[Ongreendolphinstreet in reply to 108cat]

Like you I do get mild headaches. I have been on Amiodarone and Edoxoban since AF diagnosis in Feb. Had an ablation in June which didn’t get me into NSR followed by a Cardioversion on Tuesday. This seems to have worked (for now). EP has taken me off Amiodarone, but remain on Edoxoban (Chad score of 1 - because of age). Apart from the headaches I also get regular bloodshot eyes. Will have a follow up with the EP in 4 weeks so may know more then and whether an alternative to Edoxiban has fewer side effects.

[sunlovah in reply to 108cat]

Edoxaban gave me headaches and a general feeling of unwell, so changed to apixaban.

[JoDogBlue in reply to sunlovah]

I haven't felt well since being on Edoxaban but struggle to seperate the drug from the condition it's supposed to be treating. I'll explore alternatives with the doctor. I understand the need to prevent stroke but am well aware of the bleeding risks that come with anticoagulants. It's all about balancing risk.. I'm interested in hearing the outcome of the US trials from a previous reply.

[Ppiman]

Yes - at 63, with a low Chads2 score, and after my successful ablation for atrial flutter, on stopping the bisoprolol I experienced my first (and back then) only AF episode. My consultant told me that meant I was to resume the rivaroxaban (now apixaban) and be on it for life - even with only a single episode.

Steve

[AsparagusLover]

i would take that as a yes. Have identical numbers but am female & 85 - ablation plus Amiodarone from May onwards, successful.

Have ,just stopped Amiaodarone which had been reduced due to wobbly walking pattern!

Really feel the cold on Apixaban but small price to pay to reduce stroke risk.

Good luck!

Regards Asparaguslover.

[Hartingdon]

I had ablation in Feb 2024 and came out of hospital with more drugs than I was previously on. I naively? assumed the procedure was a fix. Lots of side effects especially from Amiodarone. So I was allowed to stop taking it.... big improvement in my quality of life. As to Apixaban, yes probably for life now although I do wonder if gastro resistance aspirin would work. I'm also on 1.25mg Bisoprolol and 40mg Furosemide.

[7473 in reply to Hartingdon]

Not sure but didn’t think Aspirin was classed as an anticoagulant? Please check!

[Blueflags]

Hi JoDogBlue, I have been on Apixaban over for over 10 years and have had no side effects at all. My mother died of a massive stroke and as I have AF and multi focal tachycardia, I will not stop taking them as it gives me more confidence (although no absolute guarantee) that it will prevent a stroke. Good luck 🙂

[Sixtychick]

I had an ablation a year ago now and have to stay on Edoxaban for life.

[Karenjaninaz]

I was advised to stay on it even though my ablation seems successful. Mine was also done in April. I noticed it takes longer than three months for the heart to heal. It’s a gradual process, and I think it depends on the person’s age.

[mav7]

he said I should remain on edoxaban based on my new CHADS-VASC score of 2 (I have well controlled hypertension).

Do discuss with your doctor.

If not familiar, google CHADS score which states other factors than afib contribute to the score (hypertension, vascular disease, diabetes among them).

I try to tell my cardiologist I have well controlled hypertension but he says there is no such thing.