oke Risk Seen With Electrical LAA Isolation

The tread lately had included Eliquis and stopped p. Carey made a good point if one’s LAA is isolated, they can’t skip Eliquis. But what happens one day you sleep through a dose (just happened to me) and forget to take it? Fall asleep? Drug store on back order or you are on vacation overseas and run out?
The below article quoted Natale.

[www.tctmd.com]

Individuals on this thread think that getting all Doctors onboard with the bridging protocol should not be a issue. They are wrong because they do not feel the way when there in house EP Says it’s okay. It’s not about me disagreeing with Dr. Natale. It’s trying to convince another specialist that they are wrong and must comply. That is not the real world and I cannot travel 10 hours to Austin for a Colonoscopy etc.

It’s difficult.

I've used the Lovinox bridge twice. It was easily done and in fact on doctor would not do the procedure unless I did it.

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smackman
Individuals on this thread think that getting all Doctors onboard with the bridging protocol should not be a issue. They are wrong because they do not feel the way when there in house EP Says it’s okay.

I've heard from others who've encountered the same problem so I know it can be an issue. Ask the EP to consult with Natale or his staff, and if he won't or he still refuses to listen then fire him. You're the patient and it's your brain we're talking about here. If you have an isolated LAA and low flow velocity, he would be putting you at significant risk by stopping anticoagulants for any period of time. Don't do it.

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Carey

Individuals on this thread think that getting all Doctors onboard with the bridging protocol should not be a issue. They are wrong because they do not feel the way when there in house EP Says it’s okay.

I've heard from others who've encountered the same problem so I know it can be an issue. Ask the EP to consult with Natale or his staff, and if he won't or he still refuses to listen then fire him. You're the patient and it's your brain we're talking about here. If you have an isolated LAA and low flow velocity, he would be putting you at significant risk by stopping anticoagulants for any period of time. Don't do it.

Really FIRE HIM? Like he is going to give a rats butt when there is not many Cardiologist around much less a EP. Closest EP is in Shreveport 100 miles west.

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smackman
Really FIRE HIM? Like he is going to give a rats butt when there is not many Cardiologist around much less a EP. Closest EP is in Shreveport 100 miles west.

If he won't consult with Natale, won't follow his protocol, and won't educate himself as to why following that protocol is absolutely essential, then yes. Fire him. Driving 100 miles beats being dead or permanently disabled.

This is a Natale study from 2018. See the Conclusions section.

https://drive.google.com/file/d/15TCMJAfxevVwO44_FHe93vhrm8q9euaLtQ/view?usp=sharing



Edited 1 time(s). Last edit at 06/18/2020 05:45PM by Carey.

Here is a published copy of what Carey posted. You can select PDF to download one. See right column on the PDF.



Edited 1 time(s). Last edit at 06/19/2020 07:36AM by GeorgeN.

I will not go against Austin. NEVER HAVE NEVER WILL. It’s just hard for some to understand the gravity of Firing a Cardiologist much less a EP. My name would be black balled big time in this area. No need in further discussion. I will do what I have to do if that time comes.

Any doctor should want what's best for you regardless.
Personally, I wouldn't want a doctor that wasn't willing to listen or take advice from another doctor who has more experience with a particular situation.

Some doctors don’t want their feathers ruffled or need “permission“ from another dr. or Insecurity, independence or arrogance. In your case supply and demand if you are dependent on a local dr.

I was ECV today (2 day inconvenient due to prior covid19 testing) for flutter which switched to Af and back to flutter. I’m scheduled for another ablation where is a big big chance my LAA will be ablated. My concern is strokes. I can’t get a watchman due to the alloy allergic issues. Plus I must be very tired at night because three nights in a row (last night before the ECV too) I knew I had to take Eliquis but went to my room first to use the bathroom. I never made it back to the kitchen to take the night Eliquis dose...same for all three past evening doses I delayed 1.5, 5, and 6 hours later when I woke up. If I get my LAA isolated and sleepwalk from the couch to my bed again and again (I used to wake up as a kid with mud in my feet and the front door open), I may end up disabled like my father who had 14 strokes or my brother (both deceased) who had about 6-7. I watched them go from active men to blind in wheelchair shell of their former potential.

I also need regular colonoscopies and my gallbladder out. There will be an overlap risk between the lovenox bridge where I will be more vulnerable to clot/stroke risks. Plus I visit my son overseas and I can only get a 30 day supply of Eliquis so I may run out if flights due to covid19 are delayed. It just seems like a burden and stress. If I sleep through a Crestor dose, it’s no big deal. However I have to be realistic that perhaps when I get old and decrepit, I have to trust my quality of life to an untrained caregiver who frankly may not be zealous to follow the dosing protocol. I saw it with my parents first hand. Drooling in bed in the future —vs —not having one’s LAA isolated and living in AF and high HR flutter. Both are not an ideal quality of life, strokes are worst.