Following a successful ablation I have not had Afib for two and one half years. I am 74 years old and prone to falls because of a balance problem. So, because I am taking Eliquis, I worry about bleeding from a fall. I am going to buy an Apple Watch which will alert me to an irregular heart beat and also allow me to take an ECG - which I will do several times a day. So my question is this: if I am carefully monitoring my heartbeat using an Apple Watch why continue to take an anticoagulant?
Do I need to continue to take Eliquis? - Atrial Fibrillati...
Do I need to continue to take Eliquis?
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kurtgv
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Great question. And in fact, it's the very same question the REACT-AF trial is looking to answer. (Google the citation at end of this post).
But until the results are in, doctors and patients are making decisions based on what data we already have. At least in the United States, based on smaller studies, many ep's are letting their patients off of anticoagulation after a successful ablation, and yet an equal or greater number still advocate for anticoagulation for life, depending on the CHADS risk score.
And then of course, there is the bleed risk that you mentioned. A great question with no simple answer..
Jim
“Pill‐in‐Pocket” anticoagulation for stroke prevention in atrial fibrillation - Peigh - 2023 - Journal of Cardiovascular Electrophysiology - Wiley Online Library
Well, how do you know that you ARE NOT asymptomatic ? even after ablation. In other words if you are, and/or have been asymptomatic whereby you can have AF symptoms and not be aware of them, where you might even have an AF event and not know it, whereby your left atria (LA) was originally damaged and has never returned to its original state of being - why would you wanna play Russian Roulette.
Its probably a question for your EP or others in your medical team ...... Q1 - am I or can I still be asymptomatic after an ablation and Q2 - what is the state of my LA now I've had an ablation and can I now successfully abandon anticoagulants with no ill effects, i.e. future strokes. I assume your EP or medical team are aware of your balance problems. Also, have you disclosed to your medical team your vulnerability to falls and potential injury anticoagulants may cause.
Right at the beginning of my AF journey I was identified as being asymptomatic. right at the beginning in 2010, I was prescribed Warfarin, and after one ill fated experience over 6 months with Edoxaban, I returned to Warfarin and have elected for life. I've always rejected the ablation route simply because it comes with no guarantees with it. Apart from that, I live in a part of Britain where there is hardly an abundance of EP's much less discussing their skills and success rates !! Sure I've never had a "balance" healthcare diagnosis but, as an offset to that, I'm 80 now and ceased work in July 2024 aged 79 ( am a retired bus driver ) and so, not only did/ and do I still live in a potentially hazardous domestic environment BUT I previously worked in a potentially hazardous industrial/work environment and had to really take care of myself. BUT THE RISK WAS ALWAYS THERE. Mercifully I've always been accident free (from general stupid trips and falls and/or MVA's) , in a bus and in my private car and have never been challenged by my driver licencing authority as being an unsafe risk to myself or the general public.
I have a Withings Scan Watch which is enabled for measuring heartrates and ECG's (and a whole load of other stuff too) but the only thing I'd rely on is my Kardia. However, good though the data is from the Scan Watch it is not high quality Health Service medical grade data. I'd never let it determine whether I stayed with or rejected anticoagulants. Once you've had a stroke your balance problems will pale into insignificance both for you and your family.
Thank you for your reply and I do have a question. Doesn’t Afib show up on a ECG even if you are asymptomatic?
Yes it does, but unfortunately that is not the issue. Clots caused by AF can easily exist and break free from the heart and travel to the brain causing a stroke for up to a month following AF episode.
I stopped taking a/c after 12 months being free of AF following ablation - had a TIA a few months after that, no AF to my knowledge. That frightened me so much I couldn’t wait to get back on them and have remained on them ever since.
I am now about the same age as you and work very, very hard on my balance and proprioception to guard against falls, I think it so important as we age.
Aspirin is not an option regarding prophylactic benefit as it is an anti platelet and at a different stage of the coagulation cascade. Daily Aspirin also has different risks, especially from stomach bleeds and erosion of the stomach lining.
I do understand your dilemma, I am going for surgery shortly and visiting my cardiologist tomorrow to discuss how long I could safely not take my a/c, the surgeons want at two to three days so I need to weigh up the pros and cons and assess the risk:benefits. Never easy.
Good morning Kurtgv.
Should I or shouldn't I? Rock and a hard place isn't it.
My take? First of all you should not start or stop an antigolant without your medics say so. The current consensus is that your risk of stroke remains after a successful ablation - even if you are in sinus. Sorry, but I don't feel an Apple watch will solve this one for you. It will tell you if you are in AFib but not alert you to the risk of a stroke.
You need to balance out the risk of bleeding from a fall and the risk of a stroke. This is why I said you are in a 'rock and a hard place'. As Jim points out research is currently being undertaken concerning the question of should I / shouldn't I.
I know what I would do in your shoes - likely continue until the 'final score' is in. However, I am not a doctor. My advice is to continue to follow your medic's advice and not take matters into your own hands. Your CHADS score is likely quite high due to your age and a few other factors.
Rgds Paul
My husband’s cardiologist switched him to aspirin. He only had the one AF event and he underwent an ablation within 6 weeks of that event. He has a watch to monitor for AF and hasn’t had any since. The ablation was now over 2 years ago.
I’ve been on aspirin and I certainly wouldn’t take it in preference to an a/c. For one thing the effect of aspirin lasts for two weeks instead of a couple of days. I had a big op and was told to stop aspirin a week before. I still bled very heavily.
It’s not a patient preference scenario. It is a doctor advising his patient and putting him on aspirin. I’m not advocating one way or the other.
I see that, but it can still influence people. In this country aspirin is not considered appropriate for AF but is used in other conditions. I notice you are from another country but don’t state which one on your bio. It is good to get a perspective from another healthcare system but can be frustrating as well……
I’m in Australia. Aspirin is very appropriate on this position because it is was prescribed by a specialist. Overall I think our trust is higher in our doctors. As I said, it’s not a patient preference but the advice of someone who has specialist training in cardiac issues including AF. I think the US is also looking at it differently.
Sorry to be pedantic, but being prescribed by a specialist does not make a medication appropriate. It may very well be but if the specialist didn’t specify the reason for prescribing aspirin you don’t know what the ‘position’ is. It could be a number of things other than AF specifically.
Definitely pedantic. 
I do find it interesting how some people in this group react to aspirin being prescribed. Every time I mention it, there’s always someone who wants to tell me how wrong or inappropriate it is. I don’t see this reaction anywhere else—just here—and I find that a bit puzzling.
To be clear, I’m not advocating for aspirin or saying any other treatment is wrong. I simply shared that my husband was prescribed aspirin and explained his situation. His cardiac specialist—who sees him every six months, performed his ablation, and has a deep understanding of his condition—determined that aspirin is the best option for him. That’s really all there is to it.
If you don’t agree with that, that’s fine. I was just sharing a personal experience in response to the OP’s question, to help them.
I'm not impressed by Aspirin. My Af is familial. All five sisters and our late father have /had it - dad died of prostate cancer because of the long waiting list for treatment. One sister was admitted for a gall bladder op - her AF was diagnosed then, and because they could not lower her HR, they did not operate and sent her home with a packet of Aspirins - she had a mild stroke 2 months later
I had concerns about bleeding because I have GI problems and was having balance issues as well. I was coming up to 80 when my dose would have been reduced to half as I only weigh 47kg. So I cut my 5mg pill in half for a year or so, now on 2.5mg as I’ve reached the magic number. However I had several bangs on the head prior to that and didn’t have a brain bleed in spite of once having massive facial bruising and fractured ribs.
As a data point, I was eventually taken off anticoagulants about a year or so after my first ablation, which was successful except for ectopics. I was age 50 at the time and no other risk factors such as high BP.
Hi Kirtgv,
It’s good that you have had a successful ablation and long may it last. However, ablation is not an absolute cure, only a treatment, and AF can rear its ugly head at anytime, as many on here have experienced.
I understand your worry over a bleed if you fall, but the risk of a stroke happening is much more likely if you weigh up the odds, unless you fall everyday and knock your head.
I would be more worried of a stroke. A blood clot can form very quickly from an episode of AF. Within 30 minutes l am told. There is always the possibility of having AF in your sleep too.
Perhaps one day we may have a PIP anticoagulant which would be a great breakthrough in treatment, but until then, l think it safer to stay protected from a devastating stroke,
On a lighter note you could always wear a crash helmet.😂
Take care and keep well.
Christine
I had my second catheter ablation recently (12/24) after being free of afib for six years. My EP wanted me to stay on the Pradaxa for two months following my procedure and was fine with me dropping it after that….which I have done. Not sure what your unique circumstances are, but I would want to know why your EP has continued to advise you to keep taking your blood thinner med?
Glad your ablation was successful . The professor doing mine (UK) told me he is taking me off anticoagulants a couple of months after the ablation if all goes well ( that is if my turn on his waiting list ever arrives), I said I had heard there were two schools of thought , one that the ablation toughens the inside of the heart making you more prone to stroke, the second that the risks outweigh the benefits . He said he was firmly of the second opinion . You should ask your EP really, email his secretary. I would not be advised by a GP. Good luck
When I saw my cardiologist last week we discussed anticoagulants ( she wants to change me from Pradaxa to Rivoraxaban - sorry about the spelling if it's wrong- as it is only once a day). She was recently at a seminar and this was one of the topics. The conclusion was that women over the age of 65 regardless of Afib or not should be on anti-coagulants as their score is Chads2 (woman and aged over 65). Didn't mention men as we were discussing my treatment.
No wonder we are all confused!
Some Drs seem to think the risk of a bleed outweighs the risk of a clot while others disagree. Ultimately it's up to us to choose it seems. But I will continue on anti - coagulants!
Take care
I'm thinking your cardiologist's advice re a change of anticoagulant might have been influenced by the latest NHS DOAC commissioning advice. NHS guidance currently states that "clinicians should use the best value DOAC that is clinically appropriate for the patient". And currently generic rivaroxaban is joint best value once a day DOAC (and equal to twice a day generic apixaban ) in a ranking with 5 cost levels, while Pradaxa shows as the second most expensive DOAC available.
I would be asking my cardiologist if cost was a factor in the recommended switch? You have a right to understand your cardiologist's reasoning in order to fully agree or not with any proposed switch of anticoagulant.
I live in France so no NHS involved. In fact she left me the choice which is tough. In the NOACs Apixaban seems safer than Pradaxa and Rivoraxaban - less bleeds if one can believe published studies. My cardiologist just thought that taking one pill a day was less of a hassle but would not tell me her preference gleaned from her patients on possible side effects. A couple of members on this site suffered nasty nosebleeds. I took Pradaxa for 12 years with just a bit of indigestion. Perhaps the devil I know might be better?What do you take?
There you go, one of the reasons it's helpful to put such details in our Bios.
I have also looked into bleed risks with various DOACs as my AF was diagnosed 5 or so years after I suffered spontaneous (ie. unexplained) chronic bilateral subdural haematomas, and I fear repeat bleeds, while I was anticoagulated, could well prove fatal. Anyway haematology still recommended apixaban, apparently specifically because at that time it was considered the best given my bleed history. And it was one of the more expensive DOACs at that time as Eliquis, although now generic apixaban is equal cheapest (in UK).
The risks associated with various DOACs seem to vary as time passes and each new research article is presented, although conflicts of interests with authors is sadly an increasing trend. I quite like idea of a once a day DOAC, and the profile of the once a day edoxaban (2nd cheapest here), which is popular in Germany, but not sure if it's available in France.
Good luck with your research and your decision. It certainly is a confusing matter.
Addendum: I've just realised I didn't answer your final question.🤔
Actually, I haven't started any DOAC yet, for the reason I mentioned. I feel I'm still floating about in "rock & hard place" territory.
My honest hope is that the REACT-AF trial in USA proves the effectiveness of a PIP approach to anticoagulation. If it does, I will adopt that protocol as it should provide extended periods of time completely off anticoagulation for my paroxysmal AF. However, at the moment, final recommendations won't appear before mid 2029, and this date may be too distant to help this 78 year old.🤞
See this ...
“Pill‐in‐Pocket” anticoagulation for stroke prevention in atrial fibrillation
onlinelibrary.wiley.com/doi...
Thank you for posting this link.
You might like to read the trial protocol here ...
clinicaltrials.gov/study/NC...
Are you in USA? Your Bio doesn't indicate.
oh dear do you you really need to take an ecg and check several times a day. The worry and stress which is obviously happening will not do you any good
As far as still taking your anticoagulant I think you should discuss that with your consultant.
I have had a couple of nasty falls crashing my head as well as making a mess of the rest of me. Luckily I did go to hospital mostly because my leg was a mess and told them I had crashed my head I did have a brain bleed but was given the reversal drug and fine . Just in my opinion the risk of bleed versus a stroke is no contest I wouldn’t want a stroke. Of course no one wants a bleed either
All the best and glad your ablation is keeping you on the straight and narrow snd free
You’ve had plenty of good replies regarding the risks, I’ll just add that the Apple Watch will not reliably catch all AF episodes and for an alert to be generated you would need to be in AF for several hours and have several background checks spot irregularities, these background checks only happen when you are resting. It was the Apple Watch alert that identified my AF in the beginning but I know it had failed to alert me of several episodes in the two or three months between getting the watch and having an alert. There are a number of patients in a trial with non standard watch software to alert immediately when an irregular beat is spotted but this is not the case for the standard retail version of the watches.
My point is for you to assess your risk without relying on the watch and remove that from your calculations. Just my thoughts.
Best wishes
I’m at same place, after 6 months NSR I asked doc why? Discontinued…
If possible think about getting a Watchman installed in your heart. It plugs the Left Atrium Appendix (LAA) where 95% of blood clots form because of afib. Look it up under Boston Scientific. I have one (age 71) and was able to get off Eliquis within 6 months. I still ski and was very concerned about a head injury that could cause a slow bleed. Good luck!
From the thread you can see that there are two camps over anti coagulation. It's all about risk really. And when you're considering risk you do have to consider the risk of stroke but you also have to cinsider the risk of a bleed which can be in the head too causing a stroke. This is an individual decision and it's not an easy one for all. The CHAD Score does not take into account the risk of a serious bleed from anticoagulation. For those of us who've had serious bleeds the path is less clear and that does include risks from a fall.
I've been in this position. Having been rushed to hospital twice due to serious bleeding from anticoagulation.. Luckily, not in my brain!! In the end, I ended up on half a dose as recommended by my EP and a heart op, which closed the LAA flap and cured my Afib. Anticoagulation was stopped several months after my op. I'm relieved. And my geart meds were slowly withdrawn. For me, the risk was greater with anticoagulation than without.
Am I risk-free? No - of course not! No one is risk-free either with or without anti coagulation. Its a question of balance plus the least risky route for each person. We are all different.
I look forward to a more graduated approach to anticoagulation where the risk without and the risk of a bleed on anticoagulation is given equal consideration along with the individuals other risk factors and conditions.
Given the complexity I think this is definitely one to discuss with your own consultant.
I also look forward to the outcome of research looking at different doses of anticoagulation to reflect the populaton graph curve where those of us at either end of the curve may benifit from much lower dose or none and those at the other end may need more.
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