surgery and eliquis

Sadly recently dx with ptosis (one eye has drooping eyelid) which apparently will get worse Ophthalmologist said surgery is necessary. I am concerned about 2 things. #1 I would have to go off Eliquis for several days and fear having AF and danger of stroke. #2 concerned that after the eyelid repair I may be left with permanent blue bruising marks on eye due to having been on Eliquis. Does anyone have any info regarding these concerns? thnx

Per Eliquis - despite a short clearance half-life of about 6 hours, the apparent half-life during repeat dosing is about 12 hours, which allows twice-daily dosing to provide effective anticoagulation, but it also means that when the drug is stopped for surgery, anticoagulation persists for at least a day.

More here - [thrombosisjournal.biomedcentral.com]

Ask your ep for advice on a (shorter half life) bridging blood thinner protocol. I used that for two days before my pacemaker surgery until Eliquis half life was out of my system.

Your first fear is reasonable and largely depends on the answer to two questions:

1. What is your CHADS-Vasc score?

2. Have you had an ablation, and if so was your left atrial appendage isolated during that procedure? (The EP would have told you if so.)


The concern about permanent bruising is unfounded. I've never heard of a permanent bruise, and the surgeon is going to have you stop the Eliquis long enough that it will be out of your system.

I have bruised twice in the past two months, they being quite rare in my pre-70-year-old life, even recently. In both cases, the bruises disappeared inside of about four/five days. I take apixaban BID, 5 mg, and have done so for five+ years.

I know it varies in protocol from surgery to surgery, but most surgeons will want you to withhold any regularly taken anti-coagulants for a full day, maybe more, prior to major surgery. In your case, it's almost a day procedure...I know, not really, but it's close. There won't be any arteries or veins pierced of a size that could be lethal...put it that way. I really would not worry. You will almost certainly have a bruise around the area, and perhaps others for piercings associated with the surgery (IV, for example). With competent care, and you going about your business as soon as you can thereafter, you'll have forgotten all about this inside of about seven/eight days.

thnx great info
quote=PavanPharter]
Per Eliquis - despite a short clearance half-life of about 6 hours, the apparent half-life during repeat dosing is about 12 hours, which allows twice-daily dosing to provide effective anticoagulation, but it also means that when the drug is stopped for surgery, anticoagulation persists for at least a day.

More here - [thrombosisjournal.biomedcentral.com][/quote]

sounds like a good idea, thnx quote=susan.d]
Ask your ep for advice on a (shorter half life) bridging blood thinner protocol. I used that for two days before my pacemaker surgery until Eliquis half life was out of my system.[/quote]

thnx Carey, I am a 3 (84y female) No ablation. Thnx for thoughts about bruising, appreciate it

Quote
Carey
Your first fear is reasonable and largely depends on the answer to two questions:

1. What is your CHADS-Vasc score?

2. Have you had an ablation, and if so was your left atrial appendage isolated during that procedure? (The EP would have told you if so.)


The concern about permanent bruising is unfounded. I've never heard of a permanent bruise, and the surgeon is going to have you stop the Eliquis long enough that it will be out of your system.

thnx for encouraging info

Quote
gloaming
I have bruised twice in the past two months, they being quite rare in my pre-70-year-old life, even recently. In both cases, the bruises disappeared inside of about four/five days. I take apixaban BID, 5 mg, and have done so for five+ years.

I know it varies in protocol from surgery to surgery, but most surgeons will want you to withhold any regularly taken anti-coagulants for a full day, maybe more, prior to major surgery. In your case, it's almost a day procedure...I know, not really, but it's close. There won't be any arteries or veins pierced of a size that could be lethal...put it that way. I really would not worry. You will almost certainly have a bruise around the area, and perhaps others for piercings associated with the surgery (IV, for example). With competent care, and you going about your business as soon as you can thereafter, you'll have forgotten all about this inside of about seven/eight days.

Quote
anneh
thnx Carey, I am a 3 (84y female) No ablation. Thnx for thoughts about bruising, appreciate it

So you're actually a 2 since the guidelines were changed in 2019 to drop the point for being female.

I don't think you have anything to worry about. Check with your cardiologist/EP to be sure, but it should be safe for you to stop the Eliquis for a few days. After all, your risk of stroke is a small number to begin with, and you're only adding 5 days out of 365 to that risk. It's something like a 1.8% increase for those 5 days, which is absolutely trivial.

Quote
anneh
thnx Carey, I am a 3 (84y female)
.

Nowadays they don’t count gender on your score. It’s possible you are a 2 not a 3.

thnx again, made me a feel alot better I guess when I do get it done if I go into AF prior to surgery I would have to cancel surgery so I can take the Eliquis?

Quote
Carey

thnx Carey, I am a 3 (84y female) No ablation. Thnx for thoughts about bruising, appreciate it


So you're actually a 2 since the guidelines were changed in 2019 to drop the point for being female.

I don't think you have anything to worry about. Check with your cardiologist/EP to be sure, but it should be safe for you to stop the Eliquis for a few days. After all, your risk of stroke is a small number to begin with, and you're only adding 5 days out of 365 to that risk. It's something like a 1.8% increase for those 5 days, which is absolutely trivial.

Edited 1 time(s). Last edit at 12/14/2022 04:35PM by anneh.

That would be a good idea, yeah, and they might decline to do the surgery anyway.