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Is Blood thinner necessary with Pacemaker

Posted by NickC 
Is Blood thinner necessary with Pacemaker
January 08, 2018 11:57AM
Is it still necessary to have a blood thinner (Apixaban) even though having a pacemaker to control the A/F? I would have thought that as the pacemaker is preventing A/F then there should be no need to keep taking Apixaban.
Re: Is Blood thinner necessary with Pacemaker
January 08, 2018 01:55PM
When you say you have a pacemaker that controls your afib, do you mean you had an AV node ablation? If so, an AV node ablation doesn't prevent afib; it only prevents it from being transmitted to your ventricles and causing a rapid, irregular heartbeat. Your atria will continue to be in afib following an AV node ablation, so the need for anticoagulation doesn't go away.

Also, the need for an anticoagulant depends primarily on your CHA2DS2-Vasc score. If your afib is fully controlled and your score is 2 then an anticoagulant should be considered, and if your score is 3 or higher you probably should be on one regardless of afib status.
Re: Is Blood thinner necessary with Pacemaker
January 08, 2018 05:27PM
Hi Nick

Ditto what Carey just wrote above 👍

Re: Is Blood thinner necessary with Pacemaker
January 14, 2018 10:14AM
She didn't ever have any abelation as far as we are aware, just went straight to having a pacemaker fitted: Medtronic Sigma DR303, Pacing mode DDDR.

The person in question is not actually myself but an elderly relative.
Re: Is Blood thinner necessary with Pacemaker
January 14, 2018 11:42AM
I don't think that pacemaker is doing what you think it is. As I understand pacing modes, it sounds like she has some degree of heart block and the PM is set to provide both an atrial and ventricular beat if her heart doesn't provide either one naturally. That keeps her healthy and alive but doesn't control afib.

But whatever her situation, a pacemaker doesn't eliminate the need for anticoagulants. As I said in my first response, her CHA2DS2-Vasc score is important here. If she's over 75, she's at least a 3 and given her need for a pacemaker I would suspect she's a 4 or 5, making anticoagulants necessary even if her afib really is fully under control.
Re: Is Blood thinner necessary with Pacemaker
January 16, 2018 01:29AM
Nick, a DDDR pacer mode does not inherently indicate one that also includes a largely out of date ‘Atrial Pacing Algorithm’ feature too, which never really worked worth a damn in any event. And no, having a pacer does not require one to take a blood thinner in and of itself... Only a high enough Stroke risk score like CHADS-VASc >2.0 will typically saddle you with a blood thinner long term.

Though most EPs will also park a persistent AFibber on blood thinners too, regardless of systematic stroke risk metrics.


Edited 1 time(s). Last edit at 01/16/2018 01:31AM by Shannon.
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