Anti-coagulation after a successful ablation?

Over here in the UK many folks on AF forums expound the view that ACs are still required AFTER a 'successful' ablation as the atria are still damaged/more damaged and, as such, clots can still occur. I don't hold with this at all. Any views here??

I had a successful ablation 11 years ago and was on Warfarin for on month after, then nothing more. Other than age and it's impact on cardiac function, why take a blood thinner? I had a-fib for 10 years and it got progressively worse over time, so the ablation. Nothing wrong with my heart now.

Just my opinion

Just about any EP will require anticoagulation for the three month “blanking period” following an ablation. Beyond that, it will depend on which areas of the left atrium were ablated. For example, if the left atrial appendage (LAA) were isolated then anticoagulation would continue at least 6 months until a trans-esophageal echo (TEE) could confirm satisfactory LAA emptying velocity to discontinue oral anticoagulation. If not, then anticoagulation would continue.

The question shouldn't be solely about whether the ablation was successful or not. The main question should be what your CHA2DS2-Vasc score is. If you've got a score of 4, for example, then you should remain on anticoagulants no matter how successful your ablation was. Same with LAA isolation with a low flow volume, as wolfpack mentioned.

Consider this: A lot of people who have had afib suffer from strokes when there has been no arrhythmia for months or even years. Why would that be? The thinking is leaning away from the arrhythmia itself as being the sole cause of clot formation and toward the concept of an atrial myopathy that increase stroke risk for those with afib even when the arrhythmia has been successfully treated.

Hi Ken... Just a few additional points in an extensive topic to emphasize why the risk of clots is always of concern at any age, but often, more so in the aging population and obviously, in those who have a history of arrhythmia.

As we age, the heart muscle pumping capacity can diminish for a variety of reasons. It's all complicated by whether the heart is pumping overly thick blood or if it's relatively 'effortless' with less tendency to form clots when clearance isn't adequate. Since this forum began, many members have had successful ablations and have not been placed on life-long anticoagulants. Each case is individual and the more extensive the procedure, along with age, the more likely the anticoag requirement.

There is historical, supportive information for the cause of what is known as hyperviscosity - or thick, sticky blood - and the problems that can cause. The hemorheology pioneers investigating that about 20 years ago as a cause of stroke and heart attacks focused on sheer stress in the anatomical arterial branches of blood vessels that are often the areas of plaque accumulation as well as. The famous quote by the late Kenneth R. Kensey, MD, and hemorheology expert:

"In any complex fluid - whether it's blood, ketchup, or paint - the thinner it is, the less work it takes to pump it. Therefore, the thinner your blood, the easier it is for your heart to pump it around your body, the less the arteries will have to stretch, and the less injury the arteries will sustain."
Kenneth R. Kensey, M.D.,The Blood Thinner Cure

Dr. Kensey’s research eventually was incorporated into what is now offered as a test by Meridian Valley Labs in their Blood Viscosity Profile, [www.iplanethealth.com]

Quoting from a publication by Dr. Kensey…
Higher blood viscosity requires higher blood pressure to ensure the same
circulating blood volume. Therefore, both the burden on the heart and the forces
acting upon the vessel wall are directly influenced by changes in blood viscosity.

Today, managing hyperviscosity also encompasses lifestyle modifications and improvement goals to ensure that ‘thick, sticky blood’ risk factors are identified by in specific tests that can be monitored until improved and maintained. Silent inflammation is a huge underlying, contributing factor. These labs include: oxidative stress factors, elevated markers of homocysteine, ferritin, fibrinogen, glucose, triglyciderides, high sensitivity or Cardiac C-reactive protein (HS-CRP), hemoglobin A1C, lipoprotein(a), Interleukin 6, oxidized LDL These are standard lab tests although sometimes not typically offered to patients routinely unless they ask and even then, some report resistance. Still, it's important to know your results.

Advancing age is always a factor. And magnesium deficiency is also shown to contribute to a hypercoaguable state.

There are numerous natural aids that help reduce inflammation and the tendency for the thick, sticky blood and the other components listed for the testing.

Jackie

Good to know and my Doctors insist that I take the 81 mg aspirin. My blood pressure averages around 115 over 70, and I stay in an excellent state of fitness, so I don't worry about thick blood. CHADS2 score of 0.

Personally, I think the medical field over prescribes blood pressure medications and with the new high blood pressure standard reduced to 130 systolic, more and more will be on medications. Same with blood thinners. For me, I remain somewhat of a skeptic, but every case is different.

Ken - I'm with you. I have survived several calamities where medical treatments were not in my best interests and did harm so I'm very skeptical as well and do lots of research. Be cautious with the aspirin.

Glad you are doing so well.
Jackie

Quote
Ken
Personally, I think the medical field over prescribes blood pressure medications

I think quite the opposite, and the results of the SPRINT trial are hard to argue with. The previous hypertension guidelines doctors have followed for years were just plain wrong and needed to be changed.

Would it be better for people to lower their BP through lifestyle modifications? Of course, but we all know that's not going to happen for the vast majority of the population. What's left is a choice between medication and the extensive damage that hypertension does to multiple organ systems.

It is simply not the intent that with "the new high blood pressure standard reduced to 130 systolic, that more and more will be on medications". See New High Blood Pressure Guidlelines. The recommendation for hypertensive medication with the newly defined Stage 1 levels is only for those who have existing CVD or are at high risk (afib is not cited). The idea is generally to increase awareness in this newly defined Stage 1, and encourage lifestyle modifications. Lifestyle modifications work, but as pointed out above there are compliance issues. There is no serious evidence that natural aids are a useful substitute for lifestyle modifications or medical treatments for hypertension. As for similar claims about blood thinners, I similarly prefer the well-constructed trials and evaluations by expert practitioners, like Natale in the case of afib, and not pop-science authors who publish mainly in their own books and occasionally in third-tier journals.