After an ablation and no AFib can I stop my blood thinner Xarelto?

Posted by teacher2001 @teacher2001, Jul 14 6:41am

I am a 79 year old female who has had AFib for nine years. Last March I had a catheter ablation and have since been taken off my beta blocker Sotolol and told I no longer have AFib. Can I now go off my blood thinner Xarelto?

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I had a pulse field ablation on 23 May and have stopped taking Metoprolol and during a check in with the EP this morning I was told that I would be on Eliquis for at least another month. After that probably on Baby Aspirin.

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I would not go off any prescription unless advised to by the person prescribing it in the first place. I will explain, though, about this specific prescription:
The risk of stroke when experiencing AF is estimated to be six times what an average person bears. That is the reason for the DOAC you are taking (Direct-acting Oral Anti-Coagulant). Even after and apparently successful ablation, you are still at risk of small runs of ectopy or AF. Also, and this is important, scientists have attributed some strokes weeks and months after no detectable AF to previous runs of AF...meaning you can still get clots coming out of the left atrial appendage (LAA). This is why some electrophysiologists want their ablatees to also have a Watchman device implanted in their LAA. If the Watchman seals off over five/six months, and if a trans-esophageal echocardiogram (TEE) shows no leakage from the LAA, you CAN go off a DOAC. The EP would usually agree to this change and say you can stop taking your Xarelto.
So, congratulations on having the ablation, and I hope it continues to show that you are free from AF going forward, but you still have the 12 week Holter monitor assessment coming where you will wear one for close to 24 hours to ensure you have no serious ectopy. If you are given the all clear, from there you must negotiate with your prescribing doctor as to the risk you're willing to accept if you have no Watchman implanted. My own cardiologist and EP have me on Eliquis for life because I'm still under a risk for strokes, even though I have no AF now for 27 months. I also don't have the Watchman, and that's a big difference.

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Profile picture for gloaming @gloaming

I would not go off any prescription unless advised to by the person prescribing it in the first place. I will explain, though, about this specific prescription:
The risk of stroke when experiencing AF is estimated to be six times what an average person bears. That is the reason for the DOAC you are taking (Direct-acting Oral Anti-Coagulant). Even after and apparently successful ablation, you are still at risk of small runs of ectopy or AF. Also, and this is important, scientists have attributed some strokes weeks and months after no detectable AF to previous runs of AF...meaning you can still get clots coming out of the left atrial appendage (LAA). This is why some electrophysiologists want their ablatees to also have a Watchman device implanted in their LAA. If the Watchman seals off over five/six months, and if a trans-esophageal echocardiogram (TEE) shows no leakage from the LAA, you CAN go off a DOAC. The EP would usually agree to this change and say you can stop taking your Xarelto.
So, congratulations on having the ablation, and I hope it continues to show that you are free from AF going forward, but you still have the 12 week Holter monitor assessment coming where you will wear one for close to 24 hours to ensure you have no serious ectopy. If you are given the all clear, from there you must negotiate with your prescribing doctor as to the risk you're willing to accept if you have no Watchman implanted. My own cardiologist and EP have me on Eliquis for life because I'm still under a risk for strokes, even though I have no AF now for 27 months. I also don't have the Watchman, and that's a big difference.

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Thankyou Gloaming. xo

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@teacher2001
Why would you not be asking your medical specialist this question?

WE on MCC are not medical professionals and should not give medical advice. We are not only medical professoionals but we do not know your complete medical and mental health records including other medications and supplements you are on and any other medical or mental conditions that would important when making decisions of coming off a medication without medical professional determining the need.

Just trying to help here. Example. I have had a lot of PVCs and a poster recommended taking potassium and how much it help with their PVCs and PACs. I thought great I should try it too. However I have learned to check with my doctors before changing any medications or taking new supplements.

My Electrophysioloigist replied to a portal (Mayo) message I sent him on potassium. He said per my blood labs I was already at the high end of potassium levels and would not recommend taking any additional supplement. I hope that helps you understand your medical providers are not only medical professionals but they have your complete medical and mental health records.

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Profile picture for jc76 @jc76

@teacher2001
Why would you not be asking your medical specialist this question?

WE on MCC are not medical professionals and should not give medical advice. We are not only medical professoionals but we do not know your complete medical and mental health records including other medications and supplements you are on and any other medical or mental conditions that would important when making decisions of coming off a medication without medical professional determining the need.

Just trying to help here. Example. I have had a lot of PVCs and a poster recommended taking potassium and how much it help with their PVCs and PACs. I thought great I should try it too. However I have learned to check with my doctors before changing any medications or taking new supplements.

My Electrophysioloigist replied to a portal (Mayo) message I sent him on potassium. He said per my blood labs I was already at the high end of potassium levels and would not recommend taking any additional supplement. I hope that helps you understand your medical providers are not only medical professionals but they have your complete medical and mental health records.

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Thank you jc76 for your thoughts. I agree with you and have sent a message to my heart surgeon. I just wondered what the Mayo Clinic thought about stopping a blood thinner. I understand you are not a doctor but it helps to get various opinions about the matter. xo

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Profile picture for teacher2001 @teacher2001

Thank you jc76 for your thoughts. I agree with you and have sent a message to my heart surgeon. I just wondered what the Mayo Clinic thought about stopping a blood thinner. I understand you are not a doctor but it helps to get various opinions about the matter. xo

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@teacher2001
Good luck hope you get the information you need.

I am on 81 mg aspirin. My cardiologist and PCP long time ago when I had some clogging or arteries (but not bad enough for stents) wanted me on low dose aspirin.

Since then a lot of discussion in medical field of being on aspirin. What my PCP told me was in my case he thinks I should stay on the aspirin not only physically but mentally for me.

This is why I put that caveat that we don't have your medical records nor your medical history nor should we give you medical guidance to not do something or do it. Yes opinions and our personal exeperience with the topic but if you are told to do something or not something and it is medically or mentally condition or drug please check with your medical providers first.

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Profile picture for gloaming @gloaming

I would not go off any prescription unless advised to by the person prescribing it in the first place. I will explain, though, about this specific prescription:
The risk of stroke when experiencing AF is estimated to be six times what an average person bears. That is the reason for the DOAC you are taking (Direct-acting Oral Anti-Coagulant). Even after and apparently successful ablation, you are still at risk of small runs of ectopy or AF. Also, and this is important, scientists have attributed some strokes weeks and months after no detectable AF to previous runs of AF...meaning you can still get clots coming out of the left atrial appendage (LAA). This is why some electrophysiologists want their ablatees to also have a Watchman device implanted in their LAA. If the Watchman seals off over five/six months, and if a trans-esophageal echocardiogram (TEE) shows no leakage from the LAA, you CAN go off a DOAC. The EP would usually agree to this change and say you can stop taking your Xarelto.
So, congratulations on having the ablation, and I hope it continues to show that you are free from AF going forward, but you still have the 12 week Holter monitor assessment coming where you will wear one for close to 24 hours to ensure you have no serious ectopy. If you are given the all clear, from there you must negotiate with your prescribing doctor as to the risk you're willing to accept if you have no Watchman implanted. My own cardiologist and EP have me on Eliquis for life because I'm still under a risk for strokes, even though I have no AF now for 27 months. I also don't have the Watchman, and that's a big difference.

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So if after going through all of your procedures and "free" of aFib but considered still at high risk of developing clots, maybe aFib was not the reason for development of an original clot. I don't believe everyone who developed clots has aFib.

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Profile picture for sandw40 @sandw40

So if after going through all of your procedures and "free" of aFib but considered still at high risk of developing clots, maybe aFib was not the reason for development of an original clot. I don't believe everyone who developed clots has aFib.

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The risk of a stroke when in AF is about six (6) times what a 'normal' person will have at any age of comparison. However, the risk of a clot-induced stroke, that almost certainly being caused by a clot dislodged from the LAA, is still high for several months AFTER the fibrillation has been squelched via medications or by an ablation. This is why a competent cardiologist or EP will ask you to stay on a DOAC for at least six months, and why a great many ask their patients to consider having a Watchman implanted. If the six-month-post-implant TEE shows no leakage from a properly sealed LAA, then the patient may be advised to discontinue the DOAC if..............IF............there are no other comorbidities or known risks for stroke. Most elderly ablatees will be advised, strongly, to stay on a DOAC for the rest of their lives. It isn't cheap for many, I get that, but it's good insurance against deep vein thrombosis (it won't prevent all clotting, just retards it, and most people move around just enough when not on a bus, train, or airplane, or wheelchair, to prevent such events on their own).
So, yes, you are absolutely right....a subsequent clot and stroke may be due to something else than the AF and any clots lurking in the LAA. Those can't be helped when they happen, as in the instances in the previous paragraph. But the largest and greatest risk, of all risks associated with AF, is the one from stroke, and those are entirely due to that small grotto in the left atrial appendage.

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Profile picture for gloaming @gloaming

The risk of a stroke when in AF is about six (6) times what a 'normal' person will have at any age of comparison. However, the risk of a clot-induced stroke, that almost certainly being caused by a clot dislodged from the LAA, is still high for several months AFTER the fibrillation has been squelched via medications or by an ablation. This is why a competent cardiologist or EP will ask you to stay on a DOAC for at least six months, and why a great many ask their patients to consider having a Watchman implanted. If the six-month-post-implant TEE shows no leakage from a properly sealed LAA, then the patient may be advised to discontinue the DOAC if..............IF............there are no other comorbidities or known risks for stroke. Most elderly ablatees will be advised, strongly, to stay on a DOAC for the rest of their lives. It isn't cheap for many, I get that, but it's good insurance against deep vein thrombosis (it won't prevent all clotting, just retards it, and most people move around just enough when not on a bus, train, or airplane, or wheelchair, to prevent such events on their own).
So, yes, you are absolutely right....a subsequent clot and stroke may be due to something else than the AF and any clots lurking in the LAA. Those can't be helped when they happen, as in the instances in the previous paragraph. But the largest and greatest risk, of all risks associated with AF, is the one from stroke, and those are entirely due to that small grotto in the left atrial appendage.

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Excellent explanation gloaming. It’s been six months since my ablation and I am being monitored with holter tests. Followup is in September. I’ll wait to see what my cardiologist says but most likely I expect I will be advised to stay on the blood thinner. Scary thinking about possible strokes due to clots. xo

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Profile picture for gloaming @gloaming

The risk of a stroke when in AF is about six (6) times what a 'normal' person will have at any age of comparison. However, the risk of a clot-induced stroke, that almost certainly being caused by a clot dislodged from the LAA, is still high for several months AFTER the fibrillation has been squelched via medications or by an ablation. This is why a competent cardiologist or EP will ask you to stay on a DOAC for at least six months, and why a great many ask their patients to consider having a Watchman implanted. If the six-month-post-implant TEE shows no leakage from a properly sealed LAA, then the patient may be advised to discontinue the DOAC if..............IF............there are no other comorbidities or known risks for stroke. Most elderly ablatees will be advised, strongly, to stay on a DOAC for the rest of their lives. It isn't cheap for many, I get that, but it's good insurance against deep vein thrombosis (it won't prevent all clotting, just retards it, and most people move around just enough when not on a bus, train, or airplane, or wheelchair, to prevent such events on their own).
So, yes, you are absolutely right....a subsequent clot and stroke may be due to something else than the AF and any clots lurking in the LAA. Those can't be helped when they happen, as in the instances in the previous paragraph. But the largest and greatest risk, of all risks associated with AF, is the one from stroke, and those are entirely due to that small grotto in the left atrial appendage.

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Unfortunately most physicians don't specify if they are "competent" or not. Also people really need to consider the that there are always possible issues involved anytime someone is inserting anything into their heart. Procedures do not always end as expected. Most important take away is for people to REALLY UNDERSTAND what they are getting into and not just relying on a physician who may or may not be competent.

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