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Blood thinner

Posted by Dini 
Blood thinner
June 01, 2024 03:17PM
I have been on Xarelto for 7 months and had a successful ablation in March of this year. I have had increasing fatigue along with dizziness and am thinking this is a result of the blood thinner, and Eliquis made me feel horrible. Is the lariat for left atrial closure a good option, or might their be another DOAC that would have fewer side effects. Is there an option of a lower dose or possibly even reducing the number of times a week it’s taken?
Any insights would be so helpful.
Re: Blood thinner
June 01, 2024 03:46PM
First, I would confirm that it's the thinner causing your fatigue and not something else, like lingering mono which you previously mentioned, or even ablation recovery -- including anesthesia -- It took me many months to start feeling normal after my ablation.

This process can be tricky if anticoagulation is required, but you might start with trying another thinner. Also, depending on your CHADS score and afib burden (sounds like it's zero now?) your ep may let you off thinners either for a set period of time, or perhaps altogether to test your fatigue levels. Just don't want to see you get a Lariet (or similar) and end up still be fatigued. Feel better.

Jim
Re: Blood thinner
June 01, 2024 03:49PM
The first thing you need to do is calculate your CHADS-Vasc score. You can do that here. If your score is 0 or 1, talk to your EP about stopping the Xarelto. If it's higher than 1 then you shouldn't stop it. However, you could be a candidate for an LAA closure device such as the Lariat, Watchman, or AtriClip. There's a good description of them here. You're the type of patient these devices were designed for, so again, talk to your EP and see if you would qualify.
Re: Blood thinner
June 02, 2024 11:49PM
Quote
Carey
The first thing you need to do is calculate your CHADS-Vasc score. You can do that here. If your score is 0 or 1, talk to your EP about stopping the Xarelto. If it's higher than 1 then you shouldn't stop it. However, you could be a candidate for an LAA closure device such as the Lariat, Watchman, or AtriClip. There's a good description of them here. You're the type of patient these devices were designed for, so again, talk to your EP and see if you would qualify.

Carey, when we calculate, if we are female, we check male for the 0 since we should not be counted for a point against us for being female, correct? Next question: If we are on a BP med, but BP is ok now, do we still check for hx of hypertension? I did not have high BP til the afib & ablations. Thirdly, I had a R heart cath that showed a pulmonary pressure of 29 & a wedge pressure of 16, both #s being very borderline for PH (pulm hypertension), but my cardiologist put me on Farxiga for Left heart failure. Do I have to say I fall in a category of CHF?

My age would give me a point, & BP & CHF tho I don't feel like I have the latter, so that would be 2 points. But doesn't left heart disease fall into a category of CHF or not? I know PH has many different classification groups, and mine is he most common form of Group 2.

Had my TeleMed visit a couple wks ago & they even said my PH was "mild to say the least". My cardio is pretty strict & keeps a close check on keeping me well, I suppose. PH is a progressive disease & incurable, but at my age & w/such low levels, I think I am pretty safe. I also tolerate a tremendous amount of exercise like usual. Funny, the TEEs had my pulm pressure at 50-55, then next one said 75 with dx of severe PH, so see how wrong they can be. The R heart cath is the gold standard with direct measurement in the heart, not estimates.

All that said, I elected to stay on Eliquis 2.5 after the watchman, bec of reading what you & others chose to do. Am I still correct in doing so? My Watchman was placed 1/31/23.

Thanks & hope all I wrote is not hijacking this thread - since it is about being on the blood thinner, even after Watchman. I am just reassessing.
Re: Blood thinner
June 03, 2024 03:02AM
You're correct not to count the point for being female, but you should count the point for hypertension. I'm afraid the prescription for Farxiga probably means you need to count the point for CHF also. The PH isn't actually a criteria so nothing for that. I think you're a CHADS-Vasc 2. If I were you, I would stay on the half-dose Eliquis.

Nah, you didn't hijack the thread. smiling smiley
Re: Blood thinner
June 03, 2024 03:39AM
A very interesting point,, it’s ok not to count a point for being female, and if BP is elevated but not enough to be on meds do you still count a point for hbp? Also, what about stroke, if it’s caused by Afib but you’ve had a successful ablation do you still need to add it into the score?
Re: Blood thinner
June 03, 2024 04:40AM
Not counting the point for being female is because of a change in the guidelines published in 2019 (I believe it was 2019, too lazy to look it up right now). The point for hypertension is counted when a doctor writes hypertension in your record. If they didn't, then don't count it. But prescribing an antihypertensive is proof they did that, and not prescribing it suggests they didn't, but I'd want to verify your BP numbers against the guidelines because not all doctors are as up to date as they should be. If you've had a stroke, it counts. Having had a successful ablation doesn't undo the fact that your heart has proved that it can produce stroke-causing clots. If I'd ever had a stroke or TIA, I would absolutely, positively remain on anticoagulants for life.
Re: Blood thinner
June 03, 2024 10:37AM
Unfortunately Eliquis can’t dissolve or prevent a DVT. Traveling on long flights or being bedridden after an ablation or surgery could potentially cause a Dvt clot plus other factors I speculate as well. How I got screwed under my armpit is a mystery.

Sorry for the hyjack.
Re: Blood thinner
June 03, 2024 11:24AM
Quote
susan.d
Unfortunately Eliquis can’t dissolve or prevent a DVT. Traveling on long flights or being bedridden after an ablation or surgery could potentially cause a Dvt clot plus other factors I speculate as well. How I got screwed under my armpit is a mystery.

The newer OAC's, like Eliquis were shown to be "non-inferior" to warfarin in tests.

"Warfarin reduced the risk for ischemic stroke and systemic embolism by 67% compared to placebo (95% CI: 27-85%). " Source

My point is that none of these meds provide 100% protection, they reduce risk materially. Think seat belts & airbags in cars. They reduce the risk of death & injury in a crash. They don't provide 100% protection.
Re: Blood thinner
June 03, 2024 02:04PM
Quote
susan.d
Unfortunately Eliquis can’t dissolve or prevent a DVT. Traveling on long flights or being bedridden after an ablation or surgery could potentially cause a Dvt clot plus other factors I speculate as well..

If you read the drug information sheet on Eliquis it discusses the prophylactic administration of Eliquis for orthopedic patients that underwent hip and knee surgery. The results demonstrated that there were a small number of patients that developed both symptomatic and asymptomatic DVTs.
Re: Blood thinner
June 03, 2024 04:50PM
Quote
susan.d
Unfortunately Eliquis can’t dissolve or prevent a DVT. Traveling on long flights or being bedridden after an ablation or surgery could potentially cause a Dvt clot plus other factors I speculate as well. How I got screwed under my armpit is a mystery.
.

Just want to put a plug in here for compression knee socks for long flights and similar situations—they really help prevent clots.
Re: Blood thinner
June 03, 2024 10:21PM
I do wear that daisy on flights but my DVT is in my armpit. I was giving myself a monthly check after cancer and found this lump.

I could buy arm compression sleeves. I see a hematologist tomorrow. I’ll ask. Except it’s 97 degrees and I will wilt.

It’s my second DVT so I’m being tested for APS (Anti-Cardiolipin and anti B2-GP1 Ab labs)

Now my foot is bruised and swollen.

They should run these labs more often since AF in general creates clots. IMHO
Re: Blood thinner
June 04, 2024 12:25AM
Quote
Carey
You're correct not to count the point for being female, but you should count the point for hypertension. I'm afraid the prescription for Farxiga probably means you need to count the point for CHF also. The PH isn't actually a criteria so nothing for that. I think you're a CHADS-Vasc 2. If I were you, I would stay on the half-dose Eliquis.

Oops, looks like I am a 3 then. Maybe you did not add my age (which gives me a point).

Thanks
Re: Blood thinner
June 04, 2024 02:48AM
Quote
Madeline
Oops, looks like I am a 3 then. Maybe you did not add my age (which gives me a point).

Huh? I don't recall calculating your CHADS-Vasc score for you.
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