Anti-coagulation after a PVI ablation?

Here's one perspective:
[content.onlinejacc.org]


The above study includes the use of anticoagulants for 3-6 months post-procedure...and illustrates the danger of anti-coagulant related bleeding vs thrombus. Why not reduce the post-procedure anti-coag time period even more...such as 3-6 weeks to just get beyond any procedure-related clot formation?

For those who are not experiencing any significant arrhythmia after the procedure, is anti-coagulation by prescription drugs worth the risk of bleed-related problems? Might this be especially true for physically active persons who, for example, work in construction or participate in sports such as mountain biking, basketball, etc. ?

I am assuming that the individual checks rhythm and is not a candidate for silent afib. (It kind of bugs me that some doctors assume we're all clueless idiots and assume one cannot check his/her own pulse).

Any thoughts?



Edited 1 time(s). Last edit at 10/18/2013 01:45PM by Tom B.

Hi Tom.

In most cases where they are clearly past the first 6 weeks healing phase and have had no AFIB activity recorded on post ablation monitoring, the person can likely be just fine on 3 x a day of high quality Nattokinase taken once ever 8 hours at 100mg dose and not be exposed to any extra bleeding risks.

Its basically, saying you can go off all anti-coag under that circumstance all together or have the added safe protection, whatever amount it happens to be, from a good quality Nattokinase with 24 hour coverage in case you do have silent AFIB that often strikes at night when your are sleeping for vagal afibbers in particular.

Its easy to have some silent AFIB and miss it on just spot wrist checks if you are not very symptomatic which, by definition would be the case with 'silent AFIB'.

But I agree, after 6 weeks post ablation, if all is well and quiet, and there is no other rationale arguing for continuing AC drugs, then the prudent step would be to stop the drugs and add in Nattokinase in my view ( a Doc will obviously tell you to take 81mg of aspirin instead but go for the Nattokinase instead .. use Cardiokinase to be specific which is a stronger 'N-strain' of pharmaceutical quality Natto), as a safe yet not well defined in efficacy but nevertheless logical and sound protocol to provide a very likely decent measure of protection when there isn't an overt more serious risk involved.

Shannon

Tom B:

I wonder about that also. I had an ablation 18 months ago and have not had any episodes since. I was taking pradaxa before my ablation and aspirin at 3 months post ablation. Even on aspirin, I was doing a lot of bleeding every time I nicked myself while outside. I finally stopped the aspirin also and still bleed more than I would like when cut. I have always been able to tell when I am in AFIB, but still checked to be sure for about a year. Now, I have pretty much stopped worrying about my heart rate and am just living my life again. I don't recommend this method to anyone else, but it works for me.

Jim

My experience is a little different after my ablation in Bordeaux. When I left there they said to continue on Xeralto and then have a one week holter at between four and six weeks. The only holter available was a 48 hour one which I opted for. The other option was an event monitor which does not do me much good if there is silent action. I had the holter at about 5 weeks, on the one day that I stumbled in my eating habits and had an upset stomach. I had 187 ectopic beats, both singles and runs, but "no dangerous arythmias". I sent this test result to Pr Jais and they said to continue the Xeralto until two months post op and if there was no afib to discontinue it which I have done.

My condition post op was for a pronounced hard heart beat. This started to settle down at the same time I discontinued Xeralto. Whether this is a mere coincidence, or if the drug was contributing to it I will never know, but now at 3 months plus the hard heart beat has diminished
Ron

I had Coumadin for 6 weeks after PVI then Barrett said I could get off the stuff. That was a year ago. I take a baby aspirin when I remember.. I'm 66.

I am just past 6 weeks post ablation and no one has told me to stop taking Xarelto yet. I don't have my follow up appt. with Dr. Natale until the end of November, but am wondering if I have to stay on it longer due to work done in my left atrium and right coronary sinus - more than your standard PVI.

I just had minor eye surgery and you should see the bruise under my eye! I really don't like being on a blood thinner either, but am not sure when they will let me get off of it.

Barb

Barb, you absolutely under no circumstance should stop XEralto until Dr N tells you too!

As we discussed on the phone after your ablation, since you required an LAA isolation from all teh excess scarring and fibrosis that resulted in so much activity from your LAA, you cannot stop Xeralto until you get the results of the TEE in five more months. Only if your LAA flow rate is high enough can you stop the anti-coagulation.

Shannon

OK Shannon - I wasn't planning to stop it without Dr. Natale's permission, but was wondering after reading of all of these other people only being on it for 6 weeks... Is it at the 6 month mark after the ablation that they typically do a TEE? That would mean being on Xarelto until at least March if it is. Really hoping he can take me off of it then.

Barb