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 FAQs A-Fib Drug Therapy: Post PVI Blood Thinners

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

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 for life 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?”

You are right to be concerned about taking anticoagulants. They are not like taking vitamins. Anticoagulants are considered high risk drugs (Witt and Hansen).

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.

“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. No one should be on blood thinners unless there’s a real 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.)

Alternatives to Anticoagulants

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

•  Post-Ablation “Pill-In-The-Pocket”: Katharine emailed me several months after her successful catheter ablation. Instead of a daily anticoagulant, she carries rivaroxaban (Xarelto) with her which she would use if she felt an A-Fib episode coming on (though she’s never had to use it). The rivaroxaban would work to prevent a clot from forming. (No clinical trials have been done using this strategy,) This approach means Katharine isn’t on an anticoagulant for long periods of time or for the rest of her life.

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

•  “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.

•  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.

References for this article
Mayet, J. et al. “Anticoagulation for cardioversion of atrial arrhythmias.” European Heart Journal, (1998) 19, 548-552

Witt, Daniel W. and Hansen, Alisyn L. editorial in New Oral Anticoagulants Can Require Careful Dosing Too. by Scott Baltic. Medscape/Reuters Health Information, December 29, 2016.

Return to FAQ Drug Therapies
Last updated: Monday, August 31, 2020

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