Coming off Apixaban

[Bumpitybump]

Following an aortic valve replacement (AVR) July 2024, tissue valve, I went into persistent Afib by August 2024, back into normal sinus rhythm (NSR) following a Cardioversion in December 2024. Experienced some supraventricular ectopy and premature ventricular contractions but so far so good, stayed in NSR. GP, on advice from AFib consultant in Dec, now taking me off Apixaban. Initially post op prescription included an aspirin a day ( told it would be for life) I was taken off the aspirin when prescribed Apixaban. I have asked Dr if I should be back on aspirin now, he thinks not. Has anyone experienced of this please, is anyone on an aspirin a day post AVR? I think I still have access to arrhythmia nurses help line but have been signed off the AVR team so may not have access to their advice. GP happy for me to check with Papworth but thought I would ask if anyone has experience of this situation? Look forward to any thoughts of topic.

[BobD Volunteer]

Why not ask in BHF part of HUL if you are unable to speak to your valve team who would be my first call.

[Bumpitybump in reply to BobD]

Thank you, good idea.

[wilsond]

I think you would be advised to check all this out.Contradictory advice here it seems.

There are protocols and checks as to why Apixaban is required but I'm not clear why you have been taken off tbh

[Bumpitybump in reply to wilsond]

I guess they believe apixaban is not necessary when in normal sinus rhythm but the prospect has me slightly nervous. However, luckily I am very aware of NSR and or any occurrence of AFib, and easily confirmed with my Kardia Mobile.

[wilsond in reply to Bumpitybump]

Unless you are asleep. I agree, slightly nervous I'd be too.

[Cliff_G]

The two issues of anticoag for AF vs. replacement AV are separate. Your AV surgeon's advice should be followed if your AF consultant has said not needed.

Chat GPT's response on tissue valves, which from my experience of AV anticoag appears to be correct, is as follows:

"2. Bioprosthetic Aortic Valve Replacement (AVR)

Short-term anticoagulation:

Warfarin (INR 2.0–3.0) for 3–6 months is sometimes recommended, especially for high-risk patients.

Some guidelines allow aspirin (75–100 mg daily) alone instead of warfarin.

"Long-term anticoagulation:

Generally not required, unless other indications exist (e.g., atrial fibrillation, history of thromboembolism).

Aspirin (75–100 mg daily) is typically continued for life."

So, as others have said, best to get advice from the valve consultant. In terms of accessing them in a reasonable timescale, you could ask your GP to write to them. Usually much quicker.

[Bumpitybump in reply to Cliff_G]

Thank you for this comprehensive reply. I get that conflating the two things, AVR and AFib, is not correct. I also researched the aspirin factor and found similar details of aspirin being prescribed for following 3 months post op rather than for life. And I know my risk of stroke is low, and if I manage to continue in the right life style path no doubt I will keep it that way so Apixaban not required. I need to recognise that as a success story rather than worry about it. Thank you again for your help.

[2learn]

hi, My understanding is the need for apixaban and other blood thinners are related to your stroke risk not your AF risk. I have been on warfarin and now apixaban for 10 yrs, but for long periods not in AF but still told to continue with apixaban. If it was related to AF you would have to monitor everyday and then decide whether to dose or not, not sure blood thinners are effective like that.

[Bumpitybump in reply to 2learn]

Spot on, as I have just said in another reply, I know my stroke risk is low and need to have courage and embrace the idea of no longer needing Apixaban. Thank you for taking the time to offer me support.