← Return to My EP took me off eliquis. But I’m petrified. I’ll have a stroke now.

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Profile picture for gloaming @gloaming

@chickenfarmer I understand your position. Here is what I know, or 'think' I know 😀 :

When the left atrium is fibrillating, the circulation of blood is reduced. It can't fill properly by the time the next untimed contraction takes place. One serious outcome of this is that the 'left atrial appendage', a small pouch at upper extreme left of the left atrium, doesn't get flushed out properly with a fresh supply of blood. After a while, still in AF, whether a few minutes or several hours, the pooled and stale blood has begun to clot. Then, by bad luck, or when the heart reverts to normal sinus rhythm, which happens to you almost every time, the new vigorous refilling of the left atrium might cause one or more clots to get washed out of the LAA, and it goes out of the heart on the next ventricular contraction. Where it goes means life, life in a wheelchair or on your back, or death. It can travel to the heart, itself, and cause a heart attack because it blocks the left anterior descending artery. Or it can travel to the brain and give you a nasty stroke. Or, maybe to the lungs. Or to a kidney.

The risk of a stroke from AF rises five times ( X 5) over a normal person's risk at the same age and with a good heart. The risk of a major bleed is somewhat less. When was the last time you had a catastrophic bleed, say from a terrible fall that broke bones and had a sharp bone pierce an artery? Or in a car accident where a limb was almost completely severed? Those events are rare. and even when they do happen, someone nearby will call for help and attempt to stanch the worst of the blood loss. Minor cuts and abrasions don't even figure here. It's just the serious bleeds, and for all of us, it's very remote. But.................you do NOT want a stroke.

Last part of this...sorry, it gets long....and that is that the EP community have established that you can die from an AF related stroke months after a successful ablation or after reverting to normal sinus rhythm and not having any more AF over that long period. It is for this reason that the Watchman device was engineered and is offered to many patients. It seals off the mouth of the LAA and doesn't let any clots issue from it, ever. At that point, with a confirmatory trans-esophageal echocardiogram (TEE), your cardiologist and EP will agree, usually, to let you stop taking Eliquis/Rivaroxaban, maybe with a baby aspirin each day instead. But this depends on your overall risk. You may have other things going on that also raise your risk of a stroke....not just the history of AF.

I hope this very long explanation helps you to situate yourself in this unfortunate condition.

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Replies to "@chickenfarmer I understand your position. Here is what I know, or 'think' I know :-D :..."

@gloaming you scaring me. I was on eliquis for 3 months after afib. I was told I have a low stroke risk and I can safely go off thinners unless I go back into afib again and it becomes more frequent. I’m going to the er to check for clot and beg to be back on eliquis even tho I cant afford it.

@gloaming Yes I've heard the 5x stroke risk without Elliquis or other DOAC. My EP has me on 81mg aspirin for years after ablation. Says i should take elliquis if I get an AF spell longer than 4 hrs. i've scoureded medical literature to confirm his guidance. Seems that DOAC Rx is de rigor for most cardiologists. But there are some studies which cast doubt on the 5x rule. ARTESIA is one but there's some controversy there in that the study only looks at subclinical cases which from my reading means that the AF has not been formally diagnosed using an ECG, but is the result of implanted or smartwatch traces. Recent studies- ALONE-AF and OCEAN concludes that folks who've had ablation and are AF free don't have any higher stroke risk from aspirin compared to DOACs and the principal investigator in the ALONE study said that aspirin doens't seem to do much - so it may be consdiered placebo. MAkes sense but curiuos about your statement "EP community have established that you can die from an AF related stroke months after a successful ablation" I can't find studies which reinforce this gudiance. Bottom line: I'll bet the companies who sell Watchman LAA closure device plus thus who sell the (expensive) DOACs are scrambling to find rebuttals to these studies.