yes or no? Stop taking blood thinners before ablation..what is best practice ?

[helpeachother1234]

hello all,

I’ve been given conflicting advice from two EPs and would like to ask the community for their perspective.

1 ) one EP said I should stop taking blood thinner before my ablation

2) Another EP was horrified at this advice (which he said goes against NICE guidelines) and said I’d need to take them for a minimum of 3 weeks before the ablation, and for one month after. I’m not currently on them because my stroke risk score is 0

Which is correct? What are your experiences?

many thanks all

🙏

[mjames1]

You follow instructions from the EP who's doing the actual procedure.

Jim

[BobD Volunteer]

Some years agao it was decided that the process of ablation could cause the formation of small clots which it was decided were the cause of the brain fog which often followed ablation. It was always important to be antcioagulated for a period prior to the procedure to ensure that there were no clots present already and likewise for a period post procedure. This is all totally seperate from the CHADSVASC system which you appear to mention when you say your stroke risk is zero. Please take them.

[helpeachother1234 in reply to BobD]

Thanks Bob, this is great!

[wilsond]

Agree with Bob. Your Chadsvac score is irrelevant

[wilsond]

Also,why did your first EP even suggest that? Goes against all protocol I have ever heard of. Be interested to know why! Very strange

[helpeachother1234 in reply to wilsond]

Yes it’s strange because it’s a v exp EP

[Ducky2003 in reply to helpeachother1234]

Probably depends on what time limit you are attaching to "before my ablation" . I was told to take my last one the night before, so only a few hours prior and they gave me heparin during the procedure. Apixaban restarted the next day.You do need to be on it for some weeks before and after but perhaps the confusion lies in what I've mentioned above. They're both right but you need to clarify how many hours before the procedure you temporarily stop.

Hope that makes sense.

[Redactrice in reply to Ducky2003]

Same here.

[MarkS in reply to helpeachother1234]

Your EP is "very experienced", i.e. a bit old and not up-to-date! I would go with the 2nd EP for advice and ablation!

[Bramley01]

I have had an ablation this morning and I was told by my consultant to continue with blood thinners, they do not want to risk any clots

[FancyPants54 in reply to Bramley01]

I've been on and off Apixaban like a yoyo since the start of November when I suffered a massive nose bleed. Followed by 2 further big bleeds (hospitalised for 3 times in November) and now I've had 3 more bleeds, but these later 3 could be stopped at home (had one earlier today). Each time they take me off blood thinners for days at a time.

Nobody seems to care. Last time I was in hospital they put me on a blood clotting drug for a week!

I am so frightened of these horrible bleeds. I need a small surgery, but I've been waiting since December. And according to the consultant I paid to see privately they should have done the operation whilst I was in hospital the second time! The NHS has fallen apart. Where the the patient care in what I'm experiencing? I am terrified to move. To bend down. To go to work (where I'm alone) to drive the car. To do housework. It just want it over with. And I want them to stop risking the blood thinner removal.

[BenHall1 in reply to FancyPants54]

G'day FancyPants54,

Just to recount my own experience, starting with a question ......... are you also taking beta blockers, i.e. Bisoprolol, Nebivolol or Sotalol ?

I was first diagnosed with paroxysmal AF in January 2010. Back in those early days there were two treatment plans, basic Ablation and medication for life. I chose to go the medication for life route - which comprised - initially - Warfarin, Bisoprolol and Ramipril, later was added Felodopine. Even later still I was taken off Ramipril.

By April 2010 I was experiencing random, full flow nosebleeds. These usually kicked off between 8 and 10 am ... but sometimes much later. no warnings .... just a runny nose. That's it. I went back to my GP and she looked up in her book of magic potions and brews and said, the problem is the Bisoprolol. At the time of my diagnosis my Bisoprolol was prescribed to be taken in the morning (5mg) . The GP then said ........... take it at night. Guess what - I have never had a nose bleed since - I stayed on Bisoprolol for another 12 years, then to Nebivolol and now on Sotalol ........ all at night - no nose bleeds ever ! ever! It was not Warfarin at all.

So, that's my story ....... for me, nothing to do with anticoagulants at all. Maybe you, or someone like your Surgery Pharmacist if you have one, should research this a fair bit more, all is never what it seems !! Good luck.

John

[FancyPants54 in reply to BenHall1]

Thank you for that, but I don't think that's the case here. I've been on Apixaban and first Bisoprolol for years with never a nosebleed. And I switched to Nebivolol several years ago now and always take it at night.

Nosebleeds were never on my radar before November last year. A week before the first one I had an accident and fell heavily onto concrete. I sort of fell onto my knees and catapulted forward. My face didn't hit the concrete but was only inches away, saved by my hands. I do wonder if something got jolted.

The private consultant I saw rang this morning to offer me a cancelation operation today. But I haven't been given an MRI appointment yet so we had to let that pass. He want's to be sure he has seen everything before he operates. As he said on the phone "I don't want to miss anything". No one is saying it's the blood thinner causing the bleeds. They just want me to stop it when it happens so that I can stop bleeding and heal.

[mjames1]

I just want to add that it's imperative the electrophysiologist knows in advance whether you're on anticoagulation or not prior to the procedure.

Because in the rare event of a bleed or complication, the team must be prepared with a coordinated plan, including appropriate reversal agents. Continuing anticoagulation against instructions can undermine that preparation and increase procedural risk, even if the drug itself is considered safe.

So if you are uncomfortable, stopping anticoagulation before the procedure, discuss it with the electrophysiologist, they may actually have a legitimate concern or reason in your unique and individual case. But if after that, you both cannot come to an agreement, then simply find another ep.

Jim

[Karendeena]

My EP kept me on anticoagulants all through the ablation procedure, no problems whatsoever.

[Sixtychick]

I only had to stop my Sotalol , not the Edoxaban anti-coagulant. Unfortunately, my AFib started after I’d missed the 4th dose. Not surprising when you just stop taking it suddenly like that.!!

[Karendeena in reply to Sixtychick]

I was lucky and didn't go into AF when I stopped the Sotalol. I did though when having the procedure as I was sedated and felt everything

[Sixtychick in reply to Karendeena]

I think I shall be on it for life now, after trying to stop it in Feb and it caused my blood pressure to rise to very high levels. Now on 40 mg twice a day and BP seems ok again and I don’t need BP tablets, which made me feel awful.

[Karendeena in reply to Sixtychick]

You are on exactly the same dose as me. Do you still get monitored?

[Sixtychick in reply to Karendeena]

No-one monitors me. I have blood tests and they check my blood pressure and weight etc every year. June I think is my next one, but that is only done by a nurse.

[Karendeena in reply to Sixtychick]

How long since your ablation? Mine was March last year but still being seen by Professor Ng every 4 months. Due to see him next Monday, it will be 12 months then so not sure if this will continue. Maybe it's because I see him privately. I have my annual blood tests, due May

[Sixtychick in reply to Karendeena]

My ablation was in Sept 2023. I had my last follow up in Feb this year, but it was a bit late. Last one should be after about a year. I was signed off then.

[ochinee]

Was told to stop blood thinner 2 days before RF ablation. Started again after the surgery.

[Addamsfamily]

I now have chads score of 0 (now they’ve revised that you don’t get 1 point for being a woman!) and had my PF ablation last May.. I had to start apixaban three weeks before my ablation and was told it was very important I didn’t missed a single dose .. I continued on anticoagulation for three months afterwards

[DawnTX]

I have done it both ways. It may depend on the type of ablation. Usually, I’m told to stop about two days ahead of time now when I got my pacemaker, they continued me on them.

I don’t know what your score is about in my head. No one has a zero risk and I can’t believe they haven’t had you on them. That’s horrible. I took a bad fall a few weeks ago when I saw the the other day he was talking about. my anticoagulant and he said probably saved you from having a stroke. I slammed my head and face into metal and wood. FYI, nothing bruised and a shiner and lots of body pain but I’m OK that was my fourth in the last plus

take them stay on them the EP that wants you on them is my favorite

ask the people on here who have had strokes what they think you only have one heart and once you have that stroke, you can’t wash it away. I hope you do the right thing. Yes, doctors have conflicting opinions. Find one that makes you feel safe and cared about. It’s about prevention so you can have quality of life you know there’s no cure hopefully done you might be one of the lucky ones that barely knows you have it. Even with the I get the but they are just annoying. move on with your life. There’s things that are annoying, including people lol stay out of your mind a lot unless it’s something important to think about with the a fib. If you dwell on it, you will pay the price it will make you cuckoo.