"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013

AF Symposium 2015

Luigi Di Biase MD

Luigi Di Biase MD

Preventing TIA/Stroke During an Ablation

By Steve S. Ryan, PhD

One of the reasons for getting a catheter ablation is to lower the risk of an A-Fib stroke and protect the brain. So to have a TIA/stroke during or after an ablation is, as Dr. Luigi Di Biase of the Albert Einstein College of Medicine, Bronx, NY, states “I think the worst complication ever in the field.” That’s why patients are put on anticoagulants like warfarin before and after an ablation and heperin during the actual ablation.

Most complication statistics after an ablation are of paroxysmal A-Fib patients. But Dr. Di Biase pointed out that ablations for persistent and long-term persistent often involve more tissue burns and consequently more risk of TIAs/stroke. In these cases periprocedural anticoagulation is even more important.

Uninterrupted Xarelto & Eliquis in Ablations as Effective and Safe as Warfarin, But Not Pradaxa

Dr. Di Biase discussed the COMPARE trial which showed the superiority of a strategy of uninterrupted warfarin anticoagulation both before and after an ablation in reducing TIAs/stroke and “silent” lesions. (“Silent” cerebral ischemia are lesions that show up on an MRI but don’t seem to have any effect and often go away on their own. But doctors still worry about and don’t know the long-term effects of these silent brain tissue disruptions.) He pointed out that doctors should still use heperin during the actual ablation, as most centers do.

But what about the NOACs (Novel Oral Anticoagulants)? Are they as effective as warfarin? “We have preliminary data showing that uninterrupted strategies with rivaroxaban (Xarelto) and apixaban (Eliquis) dramatically reduce the amount of silent thromboembolic lesions as well, and are as safe as warfarin in terms of TIA and stroke.” He wasn’t able to produce these results with Pradaxa.

Still No Reversal Agents for Xarelto & Eliquis, But Change is Coming

With the use of both warfarin and heperin, there is an increased risk of bleeding. Dr. Di Biase described how at his center they use fresh frozen plasma for bleeding management of warfarin and heperin bleeds. But there are still no direct reversal agents for the NOACs. Dr. DiBiase seemed confident that a new reversal agent for apixaban and rivaroxaban looks very promising “to completely reverse the effects of these two drugs in less than four minutes.”

Editor’s Comments:
I usually don’t discuss drugs until they’ve actually been approved by the FDA. But a reversal agent for Xarelto and Eliquis does seem to be on FDA fast track for approval and would certainly be a most welcome development for A-Fib patients. It might even work better than the current reversal agents for warfarin.

(Added August, 15, 2015): An experimental drug idarucizumad has show positive results as a reversal agent for Pradaxa (dabigatran). In a new study of 90 patients who had uncontrolled bleeding with Pradaxa, idarucizumad stopped this bleeding within minutes for all 90 patients. No serious side effects were reported. FDA approval is pending.

We shouldn’t blame the FDA for approving the NOACs without any reversal process or remedy to stop bleeding. There has been an incredible need for new, different anticoagulants for nearly 40 years. It may have been worse if the FDA had kept the NOACs off of the market. 


Marzo, Kevin. Blood thinner Antidote. Bottom Line Health, Volume 29, Number 9, September 2015, p. 1.

Mundell, E.J.. Drug May Be Antidote to Bleeding Tied to Blood Thinner Pradaxa. Medline Plus. Monday, June 22, 2015. http://www.nlm.nih.gov/medlineplus/news/fullstory_153206.html

Back to top

Return to 2015 AF Symposium: My In-depth Reports Written for Patients

Last updated: Saturday, August 15, 2015

Related Posts

Follow Us
facebook - A-Fib.comtwitter - A-Fib.comlinkedin  - A-Fib.compinterest  - A-Fib.comYouTube: A-Fib Can be Cured!  - A-Fib.com

A-Fib.com is a
501(c)(3) Nonprofit

Your support is needed. Every donation helps, even just $1.00.

We Need You
A-Fib.com Mission Statement
BYA - Alerts ad Green

A-Fib.com top rated by Healthline.com for the third year.
A-Fib.com top rated by Healthline.com for the third year. 2014  2015  2016

Mug - Seek your cure - Beat Your A-Fib 200 pix wide at 300 resEncourage others
with A-Fib
click to order

Home | The A-Fib Coach | Help Support A-Fib.com | A-Fib News Archive | Tell Us What You think | Media Room | GuideStar Seal | HON certification | Disclosures | Terms of Use | Privacy Policy