Stopping Eliquis six months post successful ablation

Hello all,
I have posted only a few times in this forum but I follow frequently. I am happy to announce that at 6 months post ablation my Zio
patch came back A-fib free for the 7 days I wore it. Dr. Natale told me that I no longer have to take my Eliquis. While I was very happy to hear this I find that I am now very nervous about doing this even though I hold doctor Natale in very high regard. I know from my research on the topic that it is a controversial topic and not all EPs are on the same page with it.
I would be very happy to hear from anyone else who has had to deal with this situation and what your thoughts and feelings are on the topic.
[I am over all healthy and my Chad vasc score currently is 1. I turn75 in January 2022.] Thank you.



Edited 1 time(s). Last edit at 06/22/2021 07:59PM by frankangelo.

Was your LAA isolated?

Quote
smackman
Was your LAA isolated?

No.

You're a CHADS 1 now but in 7 months you're going to be a 2. Being a CHADS 2 means stopping Eliquis is a judgement call. Natale's judgement is that you can stop it, and I know he's very conservative about stroke risk, so you should feel confident in that decision. However, if you want to hedge your bets and feel a little more comfortable when you're 75 and above, you could ask him for half-dose Eliquis instead.

That's what I decided to do even though I'm also a CHADS 2, completely afib-free (have been for 4 years), and I've even had a Watchman device implanted, which reduces my stroke risk to the same as someone who's never had afib. My reasoning was that 1/2 dose Eliquis has an extremely low bleed risk and yet is effective at preventing clots that can arise in many places, not just the left atrium. It's a lot like taking a daily low-dose aspirin except it's a lot safer than aspirin. So it offers protection against heart attacks, DVTs, and all the other problems clots can cause. I ran that decision past Natale, my local EP, and my PCP. All three agreed.

If I were in your shoes, that's what I would do.

Quote
Carey
You're a CHADS 1 now but in 7 months you're going to be a 2. Being a CHADS 2 means stopping Eliquis is a judgement call. Natale's judgement is that you can stop it, and I know he's very conservative about stroke risk, so you should feel confident in that decision. However, if you want to hedge your bets and feel a little more comfortable when you're 75 and above, you could ask him for half-dose Eliquis instead.

That's what I decided to do even though I'm also a CHADS 2, completely afib-free (have been for 4 years), and I've even had a Watchman device implanted, which reduces my stroke risk to the same as someone who's never had afib. My reasoning was that 1/2 dose Eliquis has an extremely low bleed risk and yet is effective at preventing clots that can arise in many places, not just the left atrium. It's a lot like taking a daily low-dose aspirin except it's a lot safer than aspirin. So it offers protection against heart attacks, DVTs, and all the other problems clots can cause. I ran that decision past Natale, my local EP, and my PCP. All three agreed.

If I were in your shoes, that's what I would do.

Wow, your post hit a home run for me. It is nearest to what my thoughts have been leaning toward. What has been frustrating is I have had trouble finding literature on half dose Eliquis for people who don't meet the criteria as currently outlined: [80+, kidney function, etc.] So it's been hard for me to fully evaluate the strategy for me. I did suggest this to dr. Natale and he said it wasn't necessary but neither did he dismiss it out right as I really didn't push the issue.
If you have any links to literature regarding this issue it would be very much appreciated.Thank you so much for your input and as usual it makes good sense.

Quote
Carey
You're a CHADS 1 now but in 7 months you're going to be a 2. Being a CHADS 2 means stopping Eliquis is a judgement call. Natale's judgement is that you can stop it, and I know he's very conservative about stroke risk, so you should feel confident in that decision. However, if you want to hedge your bets and feel a little more comfortable when you're 75 and above, you could ask him for half-dose Eliquis instead..

So interesting Carey. I’m discharged and reading my online portal reports. The Er dr never examined me, never came into the room either. He only glanced at me when he was at his desk and looked up for a second. That quick glanced earned me two extra points. He gave me two points for being over 75. I am 69 ;-). Another point for being over 65 (isn’t that double points?) a point for being a woman and a point for high blood pressure. He rated me a 5.

Frankangelo, I don't know of any research that applies to your (our) specific situation, and I don't think you're going to find any. It's not a pressing medical question with lives at stake, so researchers are looking elsewhere. It's more of a clinical judgement left to doctors on a patient by patient basis, at least for now. It sounds like Natale is very confident you can stop Eliquis entirely, but if you're not comfortable with that, just say so.



Edited 1 time(s). Last edit at 06/25/2021 12:36AM by Carey.