Post op AFIB & anti coagulation drug

Posted by ernie4040 @ernie4040, Aug 23, 2023

I developed Afib within 3 days of total knee replacement, then a second AFib incident at day 7 post op and then finally at day 40 post op. I am currently 4 months without afib. I use a 6 Lead Kardiamobile device to run 2 ecg's per day and use an apple 8 watch for backup. I have been taking 10 mg eliquos since the Afib began. Do I just keep taking the drug for the rest of my life?
Unless I get a WATCHMAN device installed in the Left atrial appendage then I have to stay on Eliquos for the rest of my life. This is the information I have received from two different cardiologists. I think the doctors are concerned about being held responsible if I stopped anti coagulation on their advice and God forbid had a stroke. There is nothing in the medical literature that guides the doctors on the length of time to prescribe anti coagulation when the issue is post op afib vs persistent afib or random AFIB.

The watchman is a device that alleviates the blood clots by stopping the flow of blood in and out of this place called the left atrial appendage. It is this blood flow that is the usual cause of Afib associated blood clots . Stop the blood flow and there is no need for anti coagulation. But if we assume the Afib was post op afib and if 4 months free of AFib and if I continue to monitor myself do I really need to take the eliquos. So long as I monitor myself and would go back on the eliquos if the Afib came back I think I am okay stopping the drug.
I am fairly certain the Afib was directly related to the surgery. There is no evidence to suggest otherwise
I had an echocardiogram completed and except for mold lvh my heart is normally in size and function. I excessive 6 days per week on am indoor cycle for 10 years. I have no problem with that. Before I walked 2 to 3 miles per day for 20 years until bad back and knees put me on a bike only. I do have hypertension controlled by meds and I am 68 years old. Have others has post op AFib? As we age it is not that uncommon for knee and hip replacements surgery and especially not uncommon at all after cardiac surgery

Two cardiologists are unwilling to say I can reduce of stop to anti coagulation despite my AFib being related to total knee replacement surgery

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Like you I am arguing that I don't need anti coagulation unless the Afib returns. My 3 AFib episodes all happened within 6 weeks of having my knee replaced. Therefore ,I think it's safe to assume the Afib was related to anesthesia and or the stress to my heart and body in general of having total knee replacement. However, if the Afib returns even once then I am back to taking full dose of eliquos until I can get a watchman device installed and or obtain successfull ablation. My view is that if must see myself at having a different form of Afib and I must do all I can to diffuse the risk of blood clots and stroke. Even now I am taking 1/2 the recommended daily dose of eliquos.
I believe this dose reduces the chances of bleeding but also reduces the chance of having a blood clot if someone I was in Afib and did not detect it with my watch or kardia device. You can see I like to have some insurance in case I'm wrong. A doctor wrote it's much easier to resolve bleeding then it is a stroke. Almost all patients have 100%
Recovery from bleeding. Most do not have 100% from stroke. Many can die. I am guided by that information and it persisits in my thoughts.

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@ernie4040

Like you I am arguing that I don't need anti coagulation unless the Afib returns. My 3 AFib episodes all happened within 6 weeks of having my knee replaced. Therefore ,I think it's safe to assume the Afib was related to anesthesia and or the stress to my heart and body in general of having total knee replacement. However, if the Afib returns even once then I am back to taking full dose of eliquos until I can get a watchman device installed and or obtain successfull ablation. My view is that if must see myself at having a different form of Afib and I must do all I can to diffuse the risk of blood clots and stroke. Even now I am taking 1/2 the recommended daily dose of eliquos.
I believe this dose reduces the chances of bleeding but also reduces the chance of having a blood clot if someone I was in Afib and did not detect it with my watch or kardia device. You can see I like to have some insurance in case I'm wrong. A doctor wrote it's much easier to resolve bleeding then it is a stroke. Almost all patients have 100%
Recovery from bleeding. Most do not have 100% from stroke. Many can die. I am guided by that information and it persisits in my thoughts.

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Some anticoagulants have antidotes but not all. It sounds like you have a good plan. If I ever develop afib more frequently I will do the same. Good luck!

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@windyshores

@ernie4040 both my cardiologists now agree I should not (and never should have been) anticoagulated. At this point I have gone 28 months without a problem. Knock on wood. I am not opposed to it when needed.

If an episode lasts less than 5 hours, it is less risky, I was told. And for a 7 hour episode, I had an echocardiogram to check for clots. Not fool proof but helpful. Most of my episodes are about 2-3 hours. They are dramatic with heart rate 180+ , shortness of breath, chest pain, etc.

I don't eat after 5 and if I get a certain feeling in my chest I take GasX rather than a heart med. Everyone is different. I am not at all saying the everyone should follow my path. Only that I had to think for myself a bit rather than follow the first doc's opinion (which has changed).

It seems most people with afib do need blood thinners. But remember those come with risks too , including stroke.

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Can I ask if you have any other diagnosis like HBP?

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@bama921

Can I ask if you have any other diagnosis like HBP?

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What is HBP? High blood pressure? My blood pressure runs low....

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