Is Blood thinner necessary with Pacemaker

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.

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.

Hi Nick

Ditto what Carey just wrote above 👍

Shannon

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.

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.

Nick, a DDDR pacer mode does not inherently indicate one that also includes a largely out of date ‘Atrial Pacing Algorithm’ feature too, which never really worked worth a damn in any event.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.

Shannon



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

Problem is all of these blood thinners are lethal, there must be something that can be done to get away from them.

Warfarin causes atrial calcification and we know of too many people who have been killed by Apixaban triggered hemorrhage, what other options are there?

Quote
NickC
Problem is all of these blood thinners are lethal

Much less lethal than strokes.

Taking the blood thinners properly, if you truly need them as many Afibbers do at least until
They get rid of arryhthmia all together, is a good start Nick. Granted some folks will have problems and even die when taking these drugs as prescribed, but it’s a lower number than are likely to have a significant embolic stroke that can be even worse than death in many cases.

The key to not needing OAC drugs is not having anymore Atrial Arrhythmia. If the life style risk reduction and electrolyte repletion protocols we strongly suggest newcomers to our resource embrace here with gusto do not essentially come close to eliminating your battles with arrhythmia within a year to six months of truly dedicated effort, then continue on with life-long adoption of all these good new healthy heart habits that are Germaine to your body and condition, but don’t procrastinate much longer before partnering with the most experienced ablation EP you can possibly arrange for yourself to combine the very best of both advanced electrophysiology with the very best of integrative/Functional Medicine principles too for the best overall long-term freedom from Atrial arrhythmia as witnessed in our long Afibbers Forum history of following people for over 19 years now as the oldest AFIB patient advocacy and education resource on the web.

Cheers!
Shannon

"electrolyte repletion protocols" - not seen that, where do I find that document?

We are in the UK and it is looking impossible to see an EP as his regular Doctor refuses to make a referral.

What electrolytes are suggested and in what dosages?