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Why do Cardiologists recommend using Apixiban after an ablation?
I had a successful ablation over two years ago and have had no atrial fibrillation since that time. However, my cardiologist insists that I stay on Apixiban forever. I continue to question this, as since I have not had any atrial fibrillation are the dangers of Apixaban not more serious than not being on it. I have talked to others that I’ve had an ablation and they are not required to continue Apixaban. I have considerable inflammatory conditions and would like to take anti-inflammatories however, I’ve been advised not to because I’m on Apixiban. Has anybody else been recommended continuing this medication following a successful ablation? I’m also thinking that I could be taking more natural supplements that would thin my blood, but don’t want to risk this until I get other professional opinions.
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Your cardiologist and/or EP have to advise you based on evidence-based protocols approved by their colleges. And their insurers, too. The evidence is that your CHA2DS2-VASc score must be at least at 1.5, as one or both of them see it, or you're even higher. A score of 2 is the current demarcation point above which they insist that you take the DOAC daily. Some will agree to a half-dose. Some, like the vaunted Dr. Andre Natale at Texas Cardiac Arrhythmia Institute in Austin, tells his patients to go off a DOAC if they've had an LAA closure (Left Atrial Appendage) which is where most of the risk lies. He only does this after six months have passed from the insertion of the Watchman device into the LAA, and a TEE shows conclusively that it is both sealed and not leaking. If it seems to be leaking, he tells you sorry, you'll have to keep taking Apixaban or Xarelto.
I was on Eliquis/Apixiban and diltiazem for about 3 months following my ablation - oops, no, 5 months because I went to Nepal for 2 months and cardiologist said to stay on it until I got back. I stopped when I returned as I was no longer in a-fib. Started again when mitral valve issues arose and still on it after my mitral valve repair about 9 months ago. I see my cardiologist in April to see if I can stop again or if I have to continue to take it for the rest of my life. Hoping to at least drop to half dose since I am again no longer in afib ...we'll see.
hello - as I understand it, Mayo Clinic provides useful data - link below
and AF clinical guidelines were updated in 2023 - link below
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
lastly, Garfield is a well-respected prediction tool - link below
https://af.garfieldregistry.org/garfield-af-risk-calculator