Cardiologist suggests I can stop taking Eliquis. Any thoughts?

Posted by dsisko @dsisko, Nov 18, 2020

I have been on Eliquis for about 2 years now for afib. I had a successful ablation at Mayo in Rochester in August 2019 and have had no afib incidents that I’m aware of since that time. I track my pulse with my iwatch and regularly track my blood pressure. Both are fine. I’ve been of the understanding that I need to take Eliquis for the rest of my life, however, my cardiologist in Florida has suggested that I could stop taking the Eliquis. Has anyone had a similar situation or has stopped Eliquis because of a successful ablation?

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@dkh55

I had two episodes of Atrial flutters. both in 2020 I have been on Eliquis and Metoprolol ever since. I have yet to understand what an atrial flutter really is, and do I have to stay on these medications for ever? I have had two ablations, but am unable to get any real answers to these questions. Also is a flutter less or more dangerous than Afib.

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Flutter Can be more dangerous as it can deteriorate into or lead to complete heart block. Afib can over time with chronicity lead to heart failure (decreased cardiac output) and also can under the right circumstances cause stroke. Heart block can be fatal, Afib can be chronic but not directly fatal.

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After my first ablation, six months of no return of the AFib including 30 days of heart monitoring, I was off both Pradaxa and Sotolol. Ten years later I had my second ablation done in 2021 and was all set to get off the Sotolol and Eliquis. At my first checkup I was told that I no longer needed to take the Sotolol but I should take the Eliquis the rest of my life because of my age (73 at that time). I took the Eliquis twice a day for 2 more years dealing with bone, joint, and muscle pain daily which I finally discovered could be a side effect of the Eliquis. I was told that that was not a side effect of Eliquis so it couldn’t be the Eliquis. I finally convinced my cardiologist that I was not going to continue the Eliquis so he agreed to do a Holter monitor and I had no AFib during the wearing of the monitor so I now take a baby aspirin twice a day. I have always been able to feel when my AFib begins and I do check for it with a Kardia device if I feel even a little bit like I might be in AFib. So far it has not reoccurred. Within a week of quitting the Eliquis my daily bouts of bone, joint and muscle pain were gone. (Of course at 76 I still experience some of that from time to time but not the intensity I felt every day on the Eliquis). I do plan to have the Watchman implant eventually as an added precaution against stroke. I have found that doctors do push you to take prescription medications. So you do need to be your own advocate about what you can tolerate. I have refused to take cholesterol drugs because after ablations, angiograms, and other tests, I have never been told my arteries are bad and my cardiologists have agreed. Quality of life is more precious to me than length of life. Listen to your doctors but advocate for what your knowledge of yourself tells you. Ask questions, know what side effects drugs can cause, if possible do your own research into treatments so you have the information to make the best decisions for you. But be aware of the consequences of your choices and your responsibility for them.

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There is little to tell if one if 'worse' than the other, although flutter doesn't typically reveal itself to the 'wearer' until an EKG shows it. Flutter is regular, but out of rhythm. It's very fast, about twice the rate of fibrillation, typically. AF, on the other hand, is 'irregularly irregular'. Not only is it an off-beat rhythm, which makes it much more intrusive and anxiety-inducing than flutter, but its nature makes it irregular in how irregular it is. It comes and goes, gets worse, gets better....whereas flutter tends to stay in flutter and the patient is often not aware.

I have experience both and both, for me alone so far in my very limited experience, are about the same in terms of how I feel. AF is more 'thumpy and bumpy', but flutter still alerts me and my Galaxy watch will soon tell me there's an arrhythmia going on, what the rate is, but it won't state 'atrial fibrillation detected'. Instead, it says 'undetermined arrhythmia'. Only a 12 lead EKG can definitively show that it's flutter.

I urge you to google 'EKG showing flutter and fibrillation'. Take a look at the examples. You'll see AF had varied intervals in the QRS compex, meaning they're spaced out variably. Also, no P-wave, the small blip just prior to the Q-wave. Flutter shows two, three, four small waves between the QRS and the next one. That's the atrium getting several signals to beat in quick succession, which accounts for the rapid HR.

There is one fly in the ointment: Rapid Ventricular Response (RVR). It doesn't crop up in all instances of either flutter or AF, but if it does, it needs to be looked at within a few hours. It means the ventricles are trying to beat quickly along with the atria, and this will tire out the heart before long. This needs to be cardioverted, or meds given to stop the arrhythmia.

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@dkh55

I had two episodes of Atrial flutters. both in 2020 I have been on Eliquis and Metoprolol ever since. I have yet to understand what an atrial flutter really is, and do I have to stay on these medications for ever? I have had two ablations, but am unable to get any real answers to these questions. Also is a flutter less or more dangerous than Afib.

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You need to get new electrophysiology Cardiologist. Your current one isn’t answering your questions ??
They should explain everything in detail to you .
Esp after two ablations.
You can google the questions too . Best of luck .

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My AFIB and getting off drugs story:
I had AFIB, severe left atrial regurgitation, atrial valve not opening properly, no comorbidities.
Everyone is different, but here is my experience for what it's worth. I had mitral valve repair, ablation, and LAAC at 78, over a year-and-a half ago. No more AFIB (it can work permanently). I exercise and eat smartly (low in calories, sugar, salt, and caffeine). When I walk, I meditate by well-wishing for others. I also visualize my RNA, DNA, and all body systems being in good order. (I love order.) I got off of Eliquis after four months by wearing a heart monitor for 30 days to be sure AFIB was gone. I had to push my cardiologist to put me on the monitor. My last vital stats while sitting were 116/66, heart rate 66. I have also now weaned myself off of 12.5mg metoprolol daily and 81mg aspirin daily. (Read recent JAMA article that said low dose aspirin causes brain bleeding over time. Now it is recommended only for stroke and heart attack victims as I understand it. I have also read that metoprolol interferes with sodium and sugar levels. Too low an amount of sugar or salt can cause dizziness as I read it.) Vitals and alertness are better than ever. Daily, I do take a magnesium glycinate supplement containing 29% of RDA. Pure Encapsulations is the best brand I have found. I have read that magnesium and moderate exercise help folks to stay out of AFIB). I had a great surgeon at WakeMed in Raleigh, Dr. Boulton, who did all of the heart stuff. That was key of course. He also supports magnesium supplements. Overall, I feel extremely fortunate.
More: After a dizzy event about seven months ago, where many tests found absolutely no signs of anything abnormal, my cardiologist wanted me to have a loop recorder implanted (standard recommendation I guess). I said no for a host of loop recorder concerns and have been fine as wine ever since. My best research indicated that the probable cause of my dizziness was the metoprolol I took, combined with too low sodium and sugar intake that day as I had cut the lawn and also had done a full exercise regimen. Off metoprolol now as I said and doing fine nine months later. Hope this helps. Also, everyone should read "Undoctored”: Why Health Care Has Failed You and How You Can Become Smarter Than Your Doctor." I'm not saying that doctors are all wrong or all bad, just that you likely have the time to sort things out better than they can for your particular circumstances. Lastly, be sure to read "The AFIB Cure".

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@dkh55

I had two episodes of Atrial flutters. both in 2020 I have been on Eliquis and Metoprolol ever since. I have yet to understand what an atrial flutter really is, and do I have to stay on these medications for ever? I have had two ablations, but am unable to get any real answers to these questions. Also is a flutter less or more dangerous than Afib.

Jump to this post

In atrial fibrillation, the atria beat irregularly. In atrial flutter, the atria beat regularly, but faster than usual and more often than the ventricles, so you may have four atrial beats to every one ventricular beat.
I believe from my experience with A-flutter I was told it is less dangerous than A-fib. My first A-flutter ablation was successful but unfortunately my EP predicated I would develop A-fib as a problem later in life. He was correct and I developed A-fib for which I had an ablation in early 2019. That failed recently with short 2 or 3 day events of A-fib every month or so. So I am probably going in for a 2nd A-fib ablation. I found A-flutter more uncomfortable than A-fib. I never took any meds (except for aspirin) for A-flutter.

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@dkh55

I had two episodes of Atrial flutters. both in 2020 I have been on Eliquis and Metoprolol ever since. I have yet to understand what an atrial flutter really is, and do I have to stay on these medications for ever? I have had two ablations, but am unable to get any real answers to these questions. Also is a flutter less or more dangerous than Afib.

Jump to this post

Flutter usually takes place in the right atrium, but it can also happen in the left where the atrial fibrillation problems lie. If AF is the culprit, and if an ablation is undertaken, in something like 30% of all 'successful' ablations flutter will crop up in short order, often inside of days. The EPs know this, and they'll usually let their patients know ahead of time if they suspect this particular person might need a touchup or might still get PACs (premature atrial contractions), or might develop flutter. Remember, only about 65% of all index (first) ablations are still holding after one full year. So, the honest EP knows that he/she will see about 35% of their patients at least a second time.

Flutter is simply the musculature of whichever atrium has it contracting dutifully, as it is designed to do, to signals that come one after the other with no pausing interval. If you look at an EKG, and I strongly encourage every heart patient to learn how to read one (it takes some doing, but if doctors can do it, how hard can it be?!), there is a timing and a sequence to a normal heartbeat. There are pauses to let the various chamber fill so that their contents of blood can be propelled, or expelled, on the next contractions. It's a pump after all. With flutter, the affected atrium pretty much quivers...constantly. It never has a chance to fill with blood properly and then to expel a full volume into the receiving ventricle, which are the big pump parts of the heart. In AF, the atrium doesn't quiver...it beats. But, it's chaotic in its timing, meaning it, too, doesn't fully engorge itself with blood as it is supposed to do before it contracts and forces its contents past the mitral valve between it and the left ventricle to fill that vessel. Worse, maybe the atrium contracts at the same time as the ventricle below it, meaning it can't expel ANY of its contents, and that ventricular contraction was completely wasted energy because it sent next to no blood out through the aorta. Flutter is just a rapid 1, 2, 3, 4,,1200 half-beats that are ineffective. This leaves, just as it does with fibrillation, the other three vessels to do all the pumping...except they're not doing a good job because the one atrium is not doing its part to move a full volume of blood along.
Do you still have to take medications, maybe for life, even if an ablation is successful or if I don't seem to get any more AF or flutter? Generally...yes. Sometimes....no. The person to help you to decide is the person who has your care in her hands and who understands what your RISKS are for stroke. Generally, to help to situate you, as you get older, more goes wrong and the risk for calamity, which a stroke almost always is, is higher. If you have fibrosis inside of your heart due to an arrhythmia, or due to the scarring that ablation produces as a necessity for the signals to be blocked, or if you have some lingering arrhythmia that might let blood congeal inside your left atrial appendage (LAA), your risk for stroke is higher. This is just not-so-cheap and not-so-unintrusive insurance against a severe calamity...IF..it should happen.
I urge you to google 'CHAD2s-Vasc or use this link to calculate your risk:

https://www.mdcalc.com/calc/40/chads2-score-atrial-fibrillation-stroke-risk

My posts tend to be wordy and lengthy, big blocks of text....sorry. I hope this has been of some use to you and that you have persisted in reading it.

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@gloaming

Flutter usually takes place in the right atrium, but it can also happen in the left where the atrial fibrillation problems lie. If AF is the culprit, and if an ablation is undertaken, in something like 30% of all 'successful' ablations flutter will crop up in short order, often inside of days. The EPs know this, and they'll usually let their patients know ahead of time if they suspect this particular person might need a touchup or might still get PACs (premature atrial contractions), or might develop flutter. Remember, only about 65% of all index (first) ablations are still holding after one full year. So, the honest EP knows that he/she will see about 35% of their patients at least a second time.

Flutter is simply the musculature of whichever atrium has it contracting dutifully, as it is designed to do, to signals that come one after the other with no pausing interval. If you look at an EKG, and I strongly encourage every heart patient to learn how to read one (it takes some doing, but if doctors can do it, how hard can it be?!), there is a timing and a sequence to a normal heartbeat. There are pauses to let the various chamber fill so that their contents of blood can be propelled, or expelled, on the next contractions. It's a pump after all. With flutter, the affected atrium pretty much quivers...constantly. It never has a chance to fill with blood properly and then to expel a full volume into the receiving ventricle, which are the big pump parts of the heart. In AF, the atrium doesn't quiver...it beats. But, it's chaotic in its timing, meaning it, too, doesn't fully engorge itself with blood as it is supposed to do before it contracts and forces its contents past the mitral valve between it and the left ventricle to fill that vessel. Worse, maybe the atrium contracts at the same time as the ventricle below it, meaning it can't expel ANY of its contents, and that ventricular contraction was completely wasted energy because it sent next to no blood out through the aorta. Flutter is just a rapid 1, 2, 3, 4,,1200 half-beats that are ineffective. This leaves, just as it does with fibrillation, the other three vessels to do all the pumping...except they're not doing a good job because the one atrium is not doing its part to move a full volume of blood along.
Do you still have to take medications, maybe for life, even if an ablation is successful or if I don't seem to get any more AF or flutter? Generally...yes. Sometimes....no. The person to help you to decide is the person who has your care in her hands and who understands what your RISKS are for stroke. Generally, to help to situate you, as you get older, more goes wrong and the risk for calamity, which a stroke almost always is, is higher. If you have fibrosis inside of your heart due to an arrhythmia, or due to the scarring that ablation produces as a necessity for the signals to be blocked, or if you have some lingering arrhythmia that might let blood congeal inside your left atrial appendage (LAA), your risk for stroke is higher. This is just not-so-cheap and not-so-unintrusive insurance against a severe calamity...IF..it should happen.
I urge you to google 'CHAD2s-Vasc or use this link to calculate your risk:

https://www.mdcalc.com/calc/40/chads2-score-atrial-fibrillation-stroke-risk

My posts tend to be wordy and lengthy, big blocks of text....sorry. I hope this has been of some use to you and that you have persisted in reading it.

Jump to this post

Actually there are pauses in A-flutter. The faster the flutter the faster the pauses happen. But in order for the atrium to fire and contract it has pause first for it to contract again.
If a pause did not happen then the atrium would have a spasm like a Charlie horse in your leg. I do not think that having an atrium in a full spasm is life sustaining.

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@dkh55

I had two episodes of Atrial flutters. both in 2020 I have been on Eliquis and Metoprolol ever since. I have yet to understand what an atrial flutter really is, and do I have to stay on these medications for ever? I have had two ablations, but am unable to get any real answers to these questions. Also is a flutter less or more dangerous than Afib.

Jump to this post

Two doctors told me that A flutter was like a little cousin to A fib.

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@harveywj

Actually there are pauses in A-flutter. The faster the flutter the faster the pauses happen. But in order for the atrium to fire and contract it has pause first for it to contract again.
If a pause did not happen then the atrium would have a spasm like a Charlie horse in your leg. I do not think that having an atrium in a full spasm is life sustaining.

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There are pauses in all arrhythmias. If there were no pauses, there could be no 'rhythm' per se. Otherwise, I'm not sure what your meaning is. The point I was making is that, keeping hydrodynamics in mind, that being the science and engineering dealing with fluid flow, an atrium in flutter beats so quickly that it can't fill itself properly, and then expel the volume into the ventricle below it. This is why so many people feel out of breath and faint. Even so, a person I knew was active and didn't know he was in flutter until an EKG revealed it. So, each patient experiences arrhythmias differently, and that is why the medical community tends to deal mostly with symptoms and trying to manage them for the patient's sake.

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