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I find this conversation quite interesting. I have PAroxysmal AFib first discovered in 2016. Ablation in 2017 and Afib free for approx 4 yrs before experinceing short infrequent bouts that have morphed into a lot of PACs and longer AFIB spells. Once we had established that the ablation was successful my EP took me off Elliquis. I read and attend conferences on AFIB. It seems like the vast majority of cardiologists and EPs are wedded to the idea that DOACs should be standard forever after devloping AFIB, some even recommending it even to those folks who have their LAA occluded. After I started experienceing some short afib episodes in 2021 , I asked my EP when I should be concerned about anti coagulants, His answer is - take Elliquis if AF episode lasts longer than 4 hrs, which I do using the 'pill in a pocket' approach. There have been some recent studies which sorta susbtantiate my approach - check out OCEAN, OPTION, ARTESIA, and ALONE. All of these studies imply that DOACs do not reduce the risk of stroke in those who have undergone catheter ablation. There are some caveats so the studies don't apply to everyone but each uses data from large groups. I'm curious as to how the EP community will react to these studies.
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@chickenfarmer I asked my new cardiologist to enroll me in the REACT trial for pip eliquis. His practice does not currently have a physician enrolled but will in about 4 months. If the EP does not recommend the pip at the end of June, it is something he will ask the new Dr. in his practice. I am having a 2 week holter run starting next week, he said he doubts that I had only the one incidence 16 months ago, but would think any other runs of afib may have been silent. I guess we will see.
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@chickenfarmer They have been discussed, here and on afibbers.org forum. The drug isn't without its risks, and it's almost prohibitively expensive for many. Apart from that, there is no question that they are superior to both warfarin and acetyl-salicylic acid.
Are they necessary....for life once diagnosed with an arrhythmia? I don't feel they ought to be, but it depends....as always.....on other possible risks that might be in play. Do you sit for long periods at a gaming console or surfing on your tablet? DVT is always a possibility for those of we-the-aged who tend to sit more and longer. Do you have some AF residually, some flutter, or just PACs now and then? Each of those presents a risk of thromboembolic events, and for the reason that the LAA is not being 'flushed' out regularly, in normal sinus, of its pool of blood. The scientific community seems to have settled on the 12 hour rule, but the figure changes with the address of the EP/cardiologist being questioned. Twelve hours in AF means you take a DOAC for about a month......if...............IF.................it is self-limiting and doesn't repeat in that month. If you get another bout, now the signs are you are returning to paroxysmal AF, and not just a flu shot reaction, and you should be on a DOAC again indefinitely.
That is my understanding, as inexpert as I am, about what I have read of the literature...the most recent studies. Me, this guy, I'm calling BS. The reason is that, as soon as you have your initial run of, or return to, AF, and it lasts more than a couple of minutes, already the pooled blood in your LAA is NOT BEING REPLACED. Depending on the condition of one's heart, valves, ejection fraction, and how quickly the AF beats are taking place, you may start the congealing and clotting process in the LAA inside of seconds. One size does not fit all when it comes to heart health, heart structure, other heart defects and cardiomyopathy, and other 'remodeling' from previous bouts of AF or flutter, so we can't/shouldn't assume that the 4-12 hour rule is a good fit for every patient whose heart resumes its disordered rhythm(s).
My cardiologist told me I would be on both metoprolol and Eliquis for life. I stopped metoprolol six weeks after my second ablation for AF, but I still take the apixaban because I do sit a lot at a computer, I do fly on trans-Atlantic flights, and I'm about to turn 74 with a history of some mild heart disease and arrhythmia. It's insurance for me. But, if I ever continue to sleep while my heart goes into AF, and the chances for every patient with a successful ablation of returning to AF is rather high (sorry, it's true), then the apixaban will do its job.