AFIB stopped-should I still be taking Xarelto?

@harveywj thank you! My last afib was 10 months ago so it should happen soon! Have gone back to tai chi.

One hospital did an echo the next day to check for clots. Not sure I would rely on that!

Here is the most current information I could find regarding the "pill in the pocket" anticoagulation protocols. It's a summary article from 2023, and the impression I get is that determining the effectiveness of this method of "periodic" anticoagulation to cover stroke risks for infrequent or paroxysmal A-fib episodes is still very much a work in progress.
https://www.aerjournal.com/articles/pill-pocket-oral-anticoagulation-guided-daily-rhythm-monitoring-stroke-prevention-patients
I've wondered about it myself, as I have paroxysmal episodes of A-fib, can go for a number of months without an episode ( it's tracked on my pacemaker monitor reports), and generally the episodes are short-lived at a few seconds each. I've asked my cardiologist about discontinuing the Eliquis after it's been months since an episode. He's quoted my other risk factors ( such as a CHADS2Vasc2 score of 4) and the fact that he believes I've not seen the last of A-fib episodes, along with the records they have of longer occuring episodes of several hours each to tell me I need to continue with the Eliquis. Unfortunately, he's been right about the occurrence of recent A-fib episodes for me. I still find the idea of intermittent anticoagulation interesting, perhaps not for me, but for those without the other risk factors for stroke. If they could only be sure of just when a thromboembolic stroke occurs relative to an A-fib episode ( as I read the article it seems that is variable and disputed), they'd know the best timing for effective pill-in pocket anticoagulation.

The calculator posted above calculated both stroke and bleeding risk. I found that helpful since for me it is a wash. If I were overweight, had high blood pressure or diabetes the calculator would be different.

It seems you might have asymtompatic afib at times. That is important too. I have monitoring to make sure I am not having hidden, subclinical afib. If that happens the whole ball game shifts!

Excerpt: though the study does not include anything as yet this was in the intro:

Guidelines recommend using risk scores, such as the CHA2DS2-VASc, to inform anticoagulation decisions.9,10 However, these are based solely on clinical risk factors and do not include AF temporal patterns or burden.

A meta-analysis of almost 100,000 patients with AF showed that both the adjusted and unadjusted stroke and mortality risks are lower in paroxysmal AF.11 Similarly, the yearly stroke rate was below 1% in non-anticoagulated patients with AF paroxysms of < 23.5 hours’ duration and a CHA2DS2-VASc score between 1 and 2, suggesting a lower stroke risk in association with short AF episodes.12

The justification for continuous, long-term OAC in such patients appears to be weaker and, furthermore, indefinite OAC may expose patients with short or infrequent AF episodes to a high bleeding risk relative to the more limited benefit in stroke reduction.

A tailored or ‘pill-in-the-pocket’ OAC strategy is based upon the concept that the thromboembolic risk is dynamic in that it increases during and shortly after an AF episode and then decreases during periods of sinus rhythm. With the advent of direct oral anticoagulants (DOACs), appropriate anticoagulation is established in just a few hours and no monitoring or dose adjustments are required.

Limiting OAC to periods of AF in carefully selected patients with low stroke risk and infrequent episodes of AF may offer the same thromboembolic protection as continuous OAC, while reducing healthcare costs and bleeding complications, and potentially improving adherence.

I use my Apple watch for monitoring. It alerted me in both episodes. One lasted 2 months and the other 3 weeks. These are not very short periods like what you are describing. Also, if you are taking meds that make your blood pressure normal, are you scored as hypertensive in all these “models” that determine whether you should be prescribed Xarelto? I have a problem with a model that gives you -0- if you are 64 and a full 1 if you are 65.

I have low blood pressure. Good question about scoring medicated high bp.

When I turned 65 I said to my doctor couldn't I just go up by 0.1 instead of a whole point? So I agree!