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 FAQs A-Fib Drug Therapy: Post PVI Blood Thinners

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

17. “I’ve had a successful catheter ablation and am no longer in A-Fib. But my doctor says I need to be on a blood thinner because I could still have “silent” A-Fib—A-Fib episodes that I’m not aware of. Is there anything I can do to get off of blood thinners?”

If you’re no longer in A-Fib, you’re also no longer in danger of having an A-Fib stroke. But you can have a “normal” stroke: i.e., a stroke that doesn’t originate from being in A-Fib. That’s probably what your doctor is worried about.

“Silent” A-Fib isn’t as much a problem as in the past. Today’s A-Fib catheter ablation doctors follow their patients for long periods of time after a successful catheter ablation and use an extensive array of monitoring devices to tell if a patient is in “silent” A-Fib. (See: A Primer: Ambulatory Heart Rhythm Monitors) It’s unlikely you’d experience a long period of silent A-Fib without your doctor being aware, though doctors and monitoring devices aren’t infallible.

Most doctors say you don’t need to worry about short A-Fib episodes. Conventional wisdom says it takes 24-48 hours of being in A-Fib for a clot to form. Though some doctors think it takes as little as 5 1/2 hours of being in A-Fib for a clot to develop.

Don’t be hesitant about getting a second opinion if you’re worried about having to be on an anticoagulant. Anticoagulants increase the risk of bleeding disorders. In addition to bleeding, Pradaxa can cause stomach upset or burning, and stomach pain. According to Dr. David Graham of the FDA, “Coumadin (the most commonly prescribed anticoagulant) provides a benefit, but it is also responsible for probably more deaths than any single drug currently marketed.” No one should be on blood thinners unless there’s a real risk of stroke. (See my article: Women in A-Fib Not at Greater Risk of Stroke!)

(Be advised that no anticoagulant regimen or procedure will absolutely guarantee you will never have a stroke. Even warfarin [Coumadin] only reduces the risk of stroke by 55% to 65% in A-Fib patients.)

No one wants to be on blood thinners. You bruise easily, cuts take a long time to stop bleeding, you can’t participate in any contact sports or any activities like mountain climbing, bike riding, etc. If in an accident, you risk bleeding to death, because there is currently no practical way to reverse the anticlotting effect of the newer anticoagulants. When taking anticoagulants, there is an increased risk of developing a hemorrhagic stroke and gastrointestinal bleeding. And anticoagulants often have other bad side effects, make one feel sick, and diminish one’s quality of life.

(Added October 26, 2015:
The FDA granted “accelerated approval” to Praxbind®, a reversal agent (antidote) to Pradaxa®. Praxbind is given intravenously to patients who have uncontrolled bleeding or require emergency surgery.)

Alternatives to Anticoagulants

Here are some alternatives to taking anticoagulants (discuss with your doctor before making any changes in your treatment plan):

•  “Pill-In-The-Pocket”: Katharine had a successful catheter ablation several months ago. She emailed me that she now carries rivaroxiban (Xarelto) with her wherever she goes, though she’s never had to use it.

Rivaroxiban is a newer fast-acting anticoagulant which Katharine would use if she felt she was having an A-Fib episode. If Katharine were in an A-Fib episode, the rivaroxiban would work to prevent a clot from forming. No clinical trials have been done using this strategy, but it makes sense.

This “Pill-In-The-Pocket” approach means Katharine doesn’t have to risk taking heavy-duty anticoagulants for long periods of time or for the rest of her life. (Katharine hasn’t had any A-Fib episodes since her successful catheter ablation. But she’s happy to have rivaroxiban with her just in case.) See also: Treatments/Drug Therapies.

Be advised that this web site is not recommending or suggesting that you quit taking prescription blood thinners.

•  “Natural” Blood Thinners: Do your own research, then discuss this option with your doctor. There are several informative articles about Natural Blood Thinners at LIVESTRONG.COM and an extensive article, “Blood Thinners and Nutritional Supplement” by Dr. Lam on his website. See also Question #14 above.

•  Left Atrial Appendage (LAA) Occlusion Devices: The theory behind these devices which close off the opening of the Left Atrial Appendage is that 90%-95% of A-Fib clots come from the LAA. See Technical Innovation/The Watchman Device and Technical Innovations/The Lariat II.

References for this article

Return to FAQ Drug Therapies

Last updated: Wednesday, May 18, 2016

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