Why do Cardiologists recommend using Apixiban after an ablation?

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

My electrophysiologist at Mayo Jacksonville kept me on Coumadin after a successful pulsed field ablation in July because he said the afib can return. I don’t think of it as being a big deal. Coumadin is inexpensive and getting my INR every four weeks is do-able, especially when compared to having a stroke.

I have used this evaluation and the only points I get is that I am 73 years old. My blood pressure is on the low side usually around 110/70. My resting heart rate is under 60. I have low cholesterol And no previous heart conditions, other than I had a fib before the ablation. So it doesn’t make sense to me that I’m still on Apixiban, other than it is just the protocol that they always use.

I agree with you. It would be your choice to simply stop, and, on the face of it, you would be quite reasonable to do so. However, I'm no expert, and I know nothing else about you except what you have revealed (thanks). If you feel comfortable doing so, contact your EP or cardiologist and tell that person that you have done a LOT of reading and that your CHA2DS2-VASc score suggests you're at very low risk. You would offer that, if you ever detect ectopy, you would immediately pop a not-stale-dated apixaban and take two a day for at least a week after the reversion to NSR. Just in case. He/she might just buy that. If not...it's still your call.

So I just read recently they are questioning the 1 point for gender. Does anyone have any research that supports the change or know reasons why being female makes you more susceptible to having a stroke?

Women do somewhat worse after an ablation than men do as a very general rule. They have more hypertension and stiffer atrial walls than men do after an ablation. However, there is a lot of discussion going on currently and I, too, have seen talk of dismissing the automatic additional score of 1 assigned to women.
https://www.heartrhythmjournal.com/article/S1547-5271(25)00116-X/abstract?dgcid=raven_jbs_aip_email

Yes, I have seen this. However you think they would consider the other parameters such as low blood pressure, low resting heart rate, good cholesterol levels. Being on blood thinners has its side effects and as you age not being able to take anti-inflammatories is very functionally limiting. I am going to have to have another serious discussion with my doctor about this.

The CHA2DS2-VASc score metrics are stacked against anyone over 75. It seems like the majority of people over 75 need to be on anticoagulants. No doubt big-pharma fully endorses the concept.