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ENDOSCOPY.

Posted by JoyWin 
ENDOSCOPY.
June 29, 2018 10:54AM
Has anyone had an Edoscopy while taking Eliquis. I’m due for one in a couple of weeks and am nervous about the procedure(bleeding risk) and stopping the NOAC because I’ve had a PE in the past . Any recommendations or advice appreciated. Should I continue my supplements or stop those as well. I’m not normally nervous about things but this one has me concerned.
Re: ENDOSCOPY.
June 29, 2018 08:36PM
Those are all questions for the doctor who's doing the endoscopy. (And you didn't say what supplements you're taking.) Discuss your concerns about the PE. If s/he feels there's a significant risk then they can bridge you with heparin, which would allow the time without anticoagulation protection to be measured in hours rather than days.
Re: ENDOSCOPY.
June 29, 2018 09:26PM
Thanks for the response. I'm taking Magnesium, Taurine,Potassium ,B12,Ribose,COQ10, Omega 3,and D3 and Nexium when required. I have asked the Dr's including my cardiologist, and the usual response is you SHOULD be ok which I don't find very comforting.I'm guessing it's a damned if I do and damned if I don't event! >grinning smiley<
Re: ENDOSCOPY.
June 30, 2018 01:41PM
How long do you have to be off the Eliquis? And was there a know cause of the PE?
Re: ENDOSCOPY.
June 30, 2018 11:54PM
Hi,
48 hours off the Eliquis and they said the PE was spontaneous, however I had had the flu and had not taken OAC (Xarelto at that time for a few days)
Re: ENDOSCOPY.
July 01, 2018 12:32AM
Unless you have other factors that give you a really high CHADS score or you've had your LAA isolated, I don't think 48 hours is anything to worry about. It's a trivial increased risk.
Re: ENDOSCOPY.
July 01, 2018 11:34AM
Quote
Carey
Unless you have other factors that give you a really high CHADS score or you've had your LAA isolated, I don't think 48 hours is anything to worry about. It's a trivial increased risk.

So after an LAA isolation, how do you proceed with a surgery?
Re: ENDOSCOPY.
July 01, 2018 12:41PM
Quote
jpeters
So after an LAA isolation, how do you proceed with a surgery?

Heparin. They replace your anticoagulant with heparin a few days before the surgery and then stop it right before the surgery. Heparin has a very short half-life, so instead of being without protection for days they can stop the heparin just hours before the procedure and then resume your normal OAC as soon as it's safe to do so. This minimizes the time you're off anticoagulants.

Or you do like I'm doing, get an LAA occlusion device, and forget about anticoagulants forever.
Re: ENDOSCOPY.
July 01, 2018 02:47PM
Quote
Carey



Or you do like I'm doing, get an LAA occlusion device, and forget about anticoagulants forever.

I hope you're correct on that, and wish you the best.


Conclusions:

Thrombus formation on LAA occlusion devices was relatively frequent and was strongly associated with a higher risk of ischemic stroke on follow-up.

[www.acc.org]

edit: I thought of a conservative approach...give it at least CHAD score of 1 until there is strong long-term evidence to support no increase risk.



Edited 1 time(s). Last edit at 07/01/2018 03:03PM by jpeters.
Re: ENDOSCOPY.
July 01, 2018 04:11PM
Quote
jpeters
Conclusions:

Thrombus formation on LAA occlusion devices was relatively frequent and was strongly associated with a higher risk of ischemic stroke on follow-up.

Yes, I've seen that study. Many of the patients received no anticoagulants or antiplatelet therapy, which explains the high incidence of device thrombus. These devices were, in fact, developed for people who can't tolerate anticoagulants, so they're at extremely high risk to begin with. It's a very different story for those who receive protective therapy:

Dual antiplatelet therapy (HR, 0.10; 95% CI, 0.01-0.76; p = 0.03) and oral anticoagulation at discharge (HR, 0.26; 95% CI, 0.09-0.77; p = 0.02) were protective with respect to the risk of device thrombosis.

TCAI follows a protocol of oral anticoagulant plus dual antiplatelet therapy for 45 days, with the antiplatelet therapy continuing for six months, so they don't see those problems. The 45 day period was chosen because that's how long it takes for your heart to endothealize over the device, which eliminates the device thrombus risk. The antiplatelet therapy is continued for six months out of an abundance of caution.
Re: ENDOSCOPY.
July 01, 2018 06:07PM
Quote
Carey

The 45 day period was chosen because that's how long it takes for your heart to endothealize over the device, which eliminates the device thrombus risk. The antiplatelet therapy is continued for six months out of an abundance of caution.

I'll be interested in comparisons following the six months. Be great if there is no increased risk when taken off all protective therapy.
Re: ENDOSCOPY.
July 02, 2018 12:25AM
Quote
jpeters
I'll be interested in comparisons following the six months. Be great if there is no increased risk when taken off all protective therapy.

The results are already out there. Never mind increased risk, stroke risk is decreased by over 90%.
Re: ENDOSCOPY.
July 02, 2018 11:51AM
Quote
Carey

stroke risk is decreased by over 90%.
90% better than being on an anti-coagulent? I'd be happy with no increased risk smiling smiley

Edit: Which might be hard, given other CHADS risks unrelated to AFIB that are now left unprotected.



Edited 1 time(s). Last edit at 07/02/2018 11:56AM by jpeters.
Re: ENDOSCOPY.
July 02, 2018 05:39PM
Quote
jpeters
90% better than being on an anti-coagulent? I'd be happy with no increased risk smiling smiley

No, that's overall, but it's still 40% superior to warfarin. Basically, it puts you into the same level of risk as people who've never had afib, and it frees you from anticoagulants and the risks they carry. In particular, if you have an isolated LAA it frees you from being tethered permanently to anticoagulants and the risks of missing even a single dose. That was the deciding factor for me. The odds of me never being injured or needing any sort of medical procedure that requires me to stop ACs is very low. I didn't want that hanging over my head. Plus there's the cycling thing. I live in hilly terrain and routinely descend hills at 40+ mph. If anything goes wrong at that kind of speed on a bike, you're going to get hurt.
Re: ENDOSCOPY.
July 02, 2018 06:06PM
Quote
Carey

If anything goes wrong at that kind of speed on a bike, you're going to get hurt.

Ha...Also if you live in a more urban area and someone decides to turn left while your in the intersection (Been there....).
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