Pausing anticoagulant for surgery

[Emoryrich]

I have an upcoming surgery which should last about 90 minutes. I am to stop taking apixaban two days ahead of the surgery. I am fretting about stroke risk. Any advice or observations much appreciated.

[BenHall1]

back in the day, before all this new stuff became available I was on Warfarin and had to stop 6 DAYS prior to knee replacement surgery ( about 3 hours ). Nothing happened to me.

After surgery back in my room they gave me 2 injections of a bridging a/c - Fragmin, then later in the evening I returned to Warfarin. Aged 71 at the time.

[Emoryrich in reply to BenHall1]

Thanks, BenHall, for putting this into context for me. My gosh, that is quite a long surgery you had!

[BenHall1 in reply to Emoryrich]

Thank you. Yes it was but amazingly I was home 3 days later, into all my exercises, dressings off 3 weeks later. Back at work driving buses another 8 weeks later still .... 11 weeks after surgery. 😊

[10gingercats]

You have to be guided by your surgeon.I had Apixaban stopped for a day before an emergency hip replace following an accident. Like Ben Hall I was given Fragmin after the op.I also went into Afib during the op but no big deal they dealt with it. I was 78 at the time Op went well and hip is working well several years on.

[Emoryrich in reply to 10gingercats]

Thanks gingercats!

[mav7]

You will be fine. Just insure the surgeon coordinates with your heart specialist.

Key is also when to resume apixaban. Spinal surgery can be more complicated on when to resume.

But relax, medical professionals are well versed on the subject.

[Emoryrich in reply to mav7]

Thanks, mav7, for taking the time to give me reassurance.

[Bagrat]

Missing a few doses of apixaban is a very small risk when you consider we take it 365 days a year. Think of all the undiagnosed afibbers who don't have the privilege of treatment if that helps. Also many many people regularly forget their meds and live to tell the tale.Having said all that, I do understand your anxiety, as I'm a worrier too, but my feeling is you'll be fine

[Emoryrich in reply to Bagrat]

Thanks Bagrat -- great context. It's helpful to hear from a fellow worrier.

[BenHall1 in reply to Bagrat]

That is so well said Bagrat. Nice context.

[Ennasti]

Interestingly (or maybe not) I was given aspirin yesterday prior to my angiogram as I had to stop my my apixiban a few days before. They said the aspirin would help them if I was to experience any issues during the procedure. I’m not sure I understand this but it may be something worth chatting to your doctor about - if nothing else, it may reduces your risk a little and make you feel better about being off your apixiban?

I’m sure you’ll be ok though. Doctors don’t generally take unnecessary risks and it’s also a case of you have to. The risk of a bleed from the surgery is much greater. I will have to go off mine again in the next few weeks when they schedule my colonoscopy/gastroscopy. I always have polyps and the risk of bleeding when they snip them off is extremely high.

[Emoryrich in reply to Ennasti]

Hi Ennasti, thank you very much for the helpful, thoughtful analysis based on your real experience.

[JaneFinn]

This is something that worries me too, and I’ve put off all sorts of procedures and a gall bladder removal, in part because of my reluctance to be off Apixaban with the additional stroke risk.

It amazes me how it seems standard (in my region of the U.K. at least) to require 72 hours off Apixaban before procedures such as gastroscopy and colonoscopy, as well as full blown surgery. (I’m not sure if it really requires that long for a 12 hourly DOAC to clear the system?) Your 2 days sounds sufficient to me, but then I’m not in any way a medic!

But either way, when I asked my EP he said it’s very little risk in stopping for these amounts of time, and to go ahead. So I hope this is some reassurance … Jx

[wischo in reply to JaneFinn]

I had a full ablation for afib and only needed to stop the edoxaban the morning of the procedure only.

[Emoryrich]

Thank you, JaneFinn, for sharing your logic and for reassuring me.

[JOY2THEWORLD49]

Hi

I'm surprised not 3x 24hr days stop before surgery.

As you have been taking it regularly - it stays in the blood stream for some time. Some surgeries may include something in your infusion during GA.

I have had 3 ops since 2020 and all fine. The stroke with AF rapid and persistent which caused it , was a rogue clot but I was NOT on anti-co.agulantsat the time.

As you can imagine thefe is a stroke risk either way, bleeding or not clotting. Trying to stop bleeding during your surgery is a big one.

Also stopping for a time aftef. Adhere carefuly to any directions in restarting your medsagain.

cherio JOY. 75. (NZ)

[Emoryrich in reply to JOY2THEWORLD49]

Thanks, Joy, Good observations.

[secondtry]

I think as we get older it is important to manage, with least anxiety possible, that all pills or breaks in pills carry a risk, which is reduced if monitored by medics. Regrettably it is no longer possible to have black & white & probably never was😁.

Once that is accepted, you can get on with making the most of today 👍.

[Emoryrich in reply to secondtry]

Good observation, especially what you say about the illusion of certainty.

[oscarfox49]

I share the concerns here and I am putting off having an inguinal hernia repair because of my fears. Being a highly anxious and imaginative person who has never missed a single apixaban dose in four years, I know that if I stop taking it before the op (even three days) I will start imagining all kinds of 'stroke symptoms'. And I worry about the stress of the operation as my permanent AF will take off when I have to stop taking Sotalol too for the op. Of course the epidural runs risks of bleeding into the spinal cord if you don't stop the anticoagulant.

I know I should 'man up' but I know I will be terrified for days before and during and having had one stroke several years ago (thankfully have had a very good recovery) it is not irrational to have such fears. Just how do we cope with such things as acute anxiety itself is not helpful to outcomes?

Thank you for all the reassuring things people have posted here in the reply to Emoryrich. I hope things go really well with you. I hope you post about how it went when it is all over and I might then pluck up the courage to face my own little op. 😂

[Emoryrich in reply to oscarfox49]

Hey Oscarfox, you and I appear to be kindred spirits. Happy to see that the answers to my question are helping you too! "Manning up" is nonsense, IMO.

[JOY2THEWORLD49 in reply to oscarfox49]

Hi

You shouldn't put off your ingroinal hernia. Strangulation of your arteries is your REAL RISK.

After discovering the lump in the groin after pulling New Zealand up out of the sea .. ha ha, the Dr set me off to the Surgeon.

When I came out of there I had 3 weeks to decide whether to add on a hysterectomy . It was just further along in cut wise!

I was diagnosed with a indirect ingroinal hernia.

Children complete I did go for the other. Then, back in 1987 I had no AF.

I had bleeding from the other and not the hernia.

You will be good. I have had 3 ops since Stroke, with Rapid & Persistent AF and within 4 days told I had Thyroid Cancer.

Leave 3 x 24hr days, then op amd wait 2 complete days after.

It stays in your blood and with GA sometimes something is added.

See you after pained but fit and well. Done!

cheri JOY. 75 (NZ)

[oscarfox49 in reply to JOY2THEWORLD49]

Thanks for the good advice! I must pluck up my courage because as you say the risks of a strangulated hernia are far greater. I have found some things on the Internet about methods used to minimise the risk (as well as the scary stuff!) so must have a conversation with my doc. Unfortunately I don't get on well with my French doctor who is arrogant and unsympathetic but presumably I will get advice from the anaesthetist and surgeon. I had the other side done about 15 years ago but that was before I had had a stroke and I was much younger.

[Silvasava]

I had major abdominal surgery at the end of August, stopped edoxaban 3 days before, no issues at all. I did have a stroke in December 2019 and was put on Edoxaban then. Those of you that have put off surgery because of coming off AC's remember the surgeons want to keep you alive to benefit from their skill

[Cavalierrubie]

l would have thought if there was any risk that you would be in danger they would not proceed. They know your past medical history and all the medications you take and will be aware of any special needs. They must have done the same op. In the same situation before. To stop anticoagulant for such short time should be ok. The same as having a tooth removed. Tell them if you’re worried and they will reassure you that you will be safe. They will look after you and monitor you all the way through. I suffer with anxiety and know how you must be feeling, but on the day you will be in safe hands. Take care.

[Karendeena]

My brother was the same and he had previously had a stroke so he was very worried. All went well with no problems. I think they give you an injection to do something to the blood although I would have thought this would contradict what they ask you to do when stopping anticoagulants

[Auriculaire in reply to Karendeena]

It can't or there would be no point to it! For my first hip op an overcautious anaesthetist took me off Apixaban for 8 days before the op. A nurse came to the house and gave me Lovenox injections twice a day - this is France so no self injecting! My abdomen was black and blue with bruises by the time I went into the clinic. Altogether I was off about 10days . For the second hip 3 days off but no jabs so they must reckon that bridging is not needed for so short a time.

[Emoryrich in reply to Auriculaire]

Very helpful, thanks!

[Tapanac]

a couple of weeks ago (and many other times) I was in hospital for a week and a half and they stopped my apixaban all that time. After they half decided not to operate they did give me a couple of injections of heparin. When I went home I started my apixaban again

Now on the 23rd November I have to have a colonoscopy snd have to stop apixaban 3 days prior (also have to have GA which I never have had before so bit concerned about that with permanent afib)

I also another time had to stop everything for over a month……still here (touch wood)

All the best and try not to worry xx

[Emoryrich in reply to Tapanac]

Hi Tapanac -- this is very encouraging, thank you. My gosh, you are having quite a run. Thanks for sharing!

[dunestar]

I'm almost in the same boat. I'm going through tests to see whether I need an operation on my left lung. I have to stop Edoxaban for 3 days prior to one of the tests - a lung biopsy. But I'm happy to go with the advice of the medical team. The risk and consequences of having a bleeding episode are higher than the possibility of a stroke.

[Emoryrich in reply to dunestar]

Excellent point. Best wishes for your positive outcome and quick recovery.

[Ducky2003]

Just to give a little context. I had horrendous toothache last year. Paracetamol and Co-codamol didn't touch it. Ibruprofen is the best for dental pain but, due to being on Apixaban, I couldn't take it.I popped into my pharmacy and asked the lovely chap, if I could stop the Apixaban for a couple of days so that I could dose up on Ibruprofen.

His response was, absolutely not. Not because of stroke risk of not taking it, but he advised that Apixaban stays in your system a lot longer than folk think so I'd need to stop taking it for about a week for it to be safe enough to take Ibruprofen.

With that in mind, that would seem to suggest that there will still be sufficient anticoagulant in your system to cover you, even after not taking it for 2 days.

Hope that all makes sense. 😊

[Emoryrich in reply to Ducky2003]

Makes sense. As many other have said here, I am trying to put more faith in the experts, let them do their job.

[TamlaMotown]

Hi, I had breast surgery about 4 years ago & had to stop Apixaban 48hrs before. Like you I was worried about it but I was absolutely fine. They gave me an injection in my abdomen on the afternoon after morning surgery & told to start Apixaban the following day.

[Emoryrich in reply to TamlaMotown]

thanks, TamlaMotown! "Absoulutely" love your handle!

[TamlaMotown in reply to Emoryrich]

Hi, are you into Motown music?

[Emoryrich in reply to TamlaMotown]

Love it! The most brilliant era of music, still an influence to this day. It's my happy music even the sad songs, haha.

[Kendalghost]

I had to stop my apixaban for 5 days before surgery and after surgery too. I survived and so will you, it is natural to react this way when asked to stop medication most of us do.

[Emoryrich in reply to Kendalghost]

Thanks, Kendalghost. My default is worry, but your words and the words of others in our little community are doing me a world of good.

[SuziElley]

I had surgery earlier in the year and had to stop my Apixaban for two days before. No problems. The surgeon and anaesthetist will take good care of you.

[Emoryrich in reply to SuziElley]

Thank you Suzi. I am starting to settle down after all of the input from our generous community!

[Wombat3]

I recently had to stop anticoagulant 3 days before and then 3 days after surgery. It will be okay. Just relax and rest up after procedure. You will be expending a lot less energy so there isn’t too much to worry about. Best wishes for a speedy recovery.

[Emoryrich]

Thanks Wombat. "Relax" is the operative word. This is my first surgery and a potential lifesaver but my mind defaulted to doom. I am immensely grateful to have so many people reach out to me with their shared experience and comforting words. Thanks for taking time to write to me.

[BevCynfelyn]

I'm on Apixaban. I have to stop taking it this Friday because I'm having a mitral valve repair next Tuesday. The op will probably take 4 hours plus. I'll be on a bypass machine and could be on a ventilator in ITU for upto a couple of days afterwards. Major problems caused by stretched atrial as a result of AF

[JaneFinn in reply to BevCynfelyn]

Oh I’m sorry to hear about this, Bev - thinking of you for next week and hoping it all goes smoothly - and that recovery is way quicker than expected too 🙏🏻 Jx