Blood Thinner for women

Hi - I’m new to this forum so will provide a brief history.

Was diagnosed with a-fib in May 2019. I was 47 at that time and after several tests it appeared as lone a-fib. I started taking Bisoprolol at bedtime and a baby aspirin. Cardiologist at the time said there wasn’t much to do and not to worry if episodes were under 24hrs. I had a few more episodes in 2019 that were only a few hours and really didn’t have any impact on my day.. In May of 2020, an a-fib episode started and about 15mins later I experienced a brief TIA which only lasted a couple of minutes. We called 911 and was taken to ER as wasn’t sure what was happening. After a battery of tests, luckily no issues from TIA - and was referred to EP. Left hospital on metoprolol, xarelto and baby aspirin. Was back in a-fib within 3 days. Went for more tests and they put me on flecanide 100mg - lasted about 10 days, then back in a-fib. I was always self converting within anywhere from 12-36hrs. Episodes started to have many more symptoms and were impacting my life. We tried Sotalol 80mg - then 120mg each lasted about 10 days. The EP suggested that I would be a good candidate for ablation, so I started on Sotalol 160mg 2x daily and had ablation 2wks later July 27, 2020. Did not have any issues after ablation and was in nsr until 9/17 when EP suggested stopping Sotalol to see if ablation alone would hold. I went into a-fib a few days after stopping Sotalol- I waited for about 20hrs, but due to dizziness and nausea was instructed to go to ER. They did Cardizem drip and I converted about 6hrs later and went back on Sotalol. I’ve been in nsr since Sept.

As I’m only 49 at this point, I still am menstruating and the xarelto was causing abnormally heavy slows lasting for weeks. EP suggested as long as I wasn’t in a-fib I could stop Xarelto the one week per month, I tried this and it was fine, but then I started random bleeding, so he told me to stop Xarelto and use as a PIP - if I have an episode lasting more than an hour take one. Personally if it lasts 5 minutes I’m going to take one, but already having the TIA after only 15mins, I’m nervous about not being on the blood thinner. Any other Women experience similar issues and have any thoughts. I have GYN appt, to talk through options, but curious of anyone’s experience.

Thanks.

I'm past that age (54) but was recently talking to my EP about stopping Xerelato and using only when in Afib because I have frozen shoulders and want to use ibuprofen ... he said absolutely not. I have only converted once on my own though (just got home from a conversation today). I take dofetlide and they said that even if they do an ablation they'd likely keep me on it. So I don't think that is unusual but my congenital heart doc was less rah rah on the med after the ablation. IDK. I have been told by several docs that it isn't good to start and stop the xeralto but I do know others that do it. I am not the expert here just mentioning what I do..and have been told.

Since you've experienced a prior TIA, I think your EP is a very bold doctor telling you to take Xarelto as a PIP, and even bolder telling you to wait an hour before taking it. I think you have very good reasons for being nervous about not being on a blood thinner.

If I were you, I would stay on the Xarelto daily and put up with the periods until you can get a second opinion from both another EP and a GYN. The EP because I don't think what your current EP is recommending is safe, and a GYN to see if there's possibly another solution.

Problem #2 is that your ablation wasn't fully successful. What are your thoughts on that?

Carey -
Appreciate the input, wasn’t sure about going to another EP as I did feel comfortable with everything until the blood thinner. I do feel as though when he had me come off the meds I was only 8wks out and may have been too soon. So will probably need to try that again and see what happens, but with Covid and hospitals being so full. Don’t want to change anything right now. The bleeding was very heavy and passing large clots, which is not good either, so when discussed with EP it made sense to stop. As I said going to gyn to figure out my options on that end, as even though I seem to be stable right now, I never know when it could come back.

Eight weeks is a bit soon to come off the meds but not drastically so. It wasn't unreasonable to stop the flecainide to see if the ablation holds because you can always just restart it if it doesn't, but the Xarelto is a different matter entirely. What you're deciding here is between heavy flows with large clots and a stroke, and that's not really much of a choice. The heavy periods won't do you any harm as long as you don't become anemic, but a stroke? Way different matter. That TIA was a shot across the bow warning for you. If I were you, I would continue the Xarelto, or perhaps ask to try a different anticoagulant because it can't hurt to try. I would not stop it or use it as a PIP.

Kathy:

Do you still take baby aspirin along with Xarelto, i take Xarelto and my EP said never take an aspirin.

Yes, taking both. I have checked with multiple Pharmacists and EP and both said the 2 can be taken together safely.

re-reading theses as I was looking for Sotalol on the group. fyi I was on aspirin and Xeralto after an aortic stent and I was bleeding everywhere. (like pee... poo.. a knick would turn into a festival of fun.). Because I had to stay on the aspirin for 6 months I did stop xeralto- I mention b/c they do different things.. so for sure ask on second opinions the WHY. I always ask WHY are we doing this and what changes if I do XYZ...

Amy

so interesting. I'm amazed that your EP condones the use of xarelto as a PIP. especially with your TIA herstory.

I am now 50, had lone AF for 20 years, managing well (knock on wood, no episode since july 2020) with lifestyle / direction changes over the last 7 years. My cardio EP actually allowed me/ gave me blessing .. to do the same thing w blood thinner, but only on my request, backed up with a fair bit of research. I have had a TIA in 2013. I am recently no longer bleeding, but i had some extreme blood loss and subsequent low Fe iron whilst on xarelto. I'm also an athlete. I currently take xarelto at the slightest hint of AF, and I most definitely would not wait an hour before taking it. My EP originally suggested i stab myself w Heparin for instant blood thinning, in case of AF onset. I don't want to mess with stroke.

Wishing you continued NSR