FAQs A-Fib Ablations: Blood Thinner Post-Ablation? (2023)

FAQsA-Fib Ablations: Blood Thinner Post-Ablation?

FAQsA-Fib Ablations: Blood Thinner Post-Ablation? (1)

Catheter Ablation

“Aftermy successful Pulmonary Vein Ablation,do I still need to be on blood thinners like Coumadin, a NOAC or aspirin?”

You may still have a high CHADS2 stroke risk score or other factors that make it necessary for you to stay on blood thinners. For example, if your Left Atrial Appendage (LAA) isn’t pumping out properly, clots are more likely to form.

(Video) What is the success rate for atrial fibrillation ablation procedure?

But if you no longer have A-Fib, you are no longer in danger of having an A-Fib stroke. So, in most cases, you don’t need to be on blood thinners.

A study in 2010 indicates that anticoagulants, like warfarin,can be stopped 3-6 months after a successful Pulmonary Vein Ablation (Isolation).

A recent observational study involving nearly 38,000 patients found that the stroke risk of patients who had a successful catheter ablation was similar to patients with no history of A-Fib. When you are in sinus rhythm, your stroke risk is basically the same as a normal heart-healthy person. But “normal” people can experience strokes from non-A-Fib stroke risk factors.

Added !0/13/21: In a systematic review of 16 studies comparing catheter ablated patients on-and-off anticoagulants after their procedure, there was no significant difference in cerebrovascular events (strokes) between patients on- and off-anticoagulants. “This result persisted after stratification by CHADS2 and CHA2DS2-VASc score.” And off-anticoagulation patients suffered significantly less bleeding.

However, there is no medication or treatment that would absolutely guarantee one would never get a stroke, even for people in normal sinus rhythm.

“Anticoagulant treatment for people with A-Fib ranks as one of the highest-risk treatments in older Americans. ∼Thomas J. Moore, MD

Taking anticoagulants because you might develop A-Fib, however, is like taking out your appendix because at some future date you might develop appendicitis (frowned upon these days).As prolific blogger Dr. John Mandrola says, “And if there is no A-Fib, there is no benefit from anticoagulation.”

Aspirin is No Longer Recommended as First-Line Therapy:Aspirin is no longer recommended as first-line therapy for Atrial Fibrillation patients according to the 2014 AHA/ACC/HRS Treatment Guidelines for Atrial Fibrillation and the 2012 European ESC guidelines for the Management of Atrial Fibrillation.

When is aspirin appropriate? Aspirin is recommended for “secondary” prevention of cardiovascular disease such as to prevent a reoccurrence of a stroke or heart attack.

Silent A-Fib May Appear Post-Ablation

However, though feeling cured of your A-Fib, you may still be experiencing ‘silent A-Fib’ (A-Fib with no symptoms) which can be dangerous.

(Video) I Had an Ablation to Treat AFIB - 6 Things You Must Know

But doctors today are very good at spotting silent A-Fib and have a wide variety of monitoring devices (such as the Zio patch which you wear like a Band-Aid for two weeks or the Medtronic Reveal LINQ loop recorder which lasts for 3 years) to alert your doctor that you may still need to be on anticoagulants.

Danger of Taking Anticoagulants

No one should be on anticoagulants unless there is a real risk of stroke. Anticoagulants have their own risks and dangers.

Anticoagulants are not like taking vitamins (contrary to the impression of TV ads for NOACs).

No one should be on anticoagulants unless there is a real risk of stroke. Anticoagulants have their own risks and dangers.They are considered high risk drugs. 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.

“Anticoagulant treatment for people with A-Fib ranks as one of the highest-risk treatments in older Americans,” according to Thomas J. Moore, senior scientist at the Institute for Safe Medication Practices. “More than 15% of older patients treated for A-Fib with blood thinners for 1 year have bleeding.”

Bottom Line

Whether you should be on anticoagulants after a successful catheter ablation is a judgment call for you and your doctor.

References for this Article

• Bunch, J.T. et al. “Catheter ablation may reduce stroke risk in atrial fibrillation patients.” Cardiac Rhythm News, Thursday, 05 Sept 2013 14:15. http://www.cxvascular.com/crn-latest-news/cardiac-rhythm-news—latest-news/catheter-ablation-may-reduce-stroke-risk-in-atrial-fibrillation-patients

(Video) Catheter Ablation Procedure: What is it and how does it help an irregular heart beat?

• Mandrola, John. Atrial Flutter–15 facts you may want to know. In AF Ablation, Atrial fibrillation. August 5, 2013.

• Themistoclakis S. et al. “The risk of thromboembolism and need for oral anticoagulation after successful atrial fibrillation ablation.” J Am Coll Cardiol. 2010 Feb 23;55(8):735-43. http://www.ncbi.nlm.nih.gov/pubmed/20170810?dopt=Abstract

•“Oral anticoagulants are high-risk medications.” Wilt, Daniel M. and Hensen, Alisyn L. Editorial in New Oral Anticoagulants Can Require Careful Dosing Too by Scott Baltic. Medscape/Reuters Health Information, December 29, 2016http://www.medscape.com/viewarticle/873821?src=wnl_edit_tpal[

• Doheney, Kathleen/ Blood Thinner Pradaxa: What You Should Know. WebMD Health News, July 25, 2014. http://www.webmd.com/stroke/news/20140725/blood-thinner-Pradaxa

• Navarrete, A. et al. “Ablation of atrial fibrillation at the time of cavotricuspid isthmus ablation in patients with atrial flutter without documented atrial fibrillation derives a better long-term benefit.” Journal of Cardiovascular Electrophysiology, July 19, 2010 (Epub ahead of print)

• 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. published online March 28, 2014, 4.2.1. Antiplatelet Agents, p 29.doi: 10.1161/CIR.0000000000000041 Last accessed Nov 23, 2014.URL: From http://content.onlinejacc.org/article.aspx?articleid=1854230

• ESC Management of Atrial Fibrillation 2010 and Focused Update (2012): ESC Clinical Practice Guidelines. European Society of Cardiology URL: http://www.escardio.org/Guidelines-&-Education/Clinical-Practice-Guidelines/Atrial-Fibrillation-Management-of-2010-and-Focused-Update-2012

• Shallenberger, Frank. Does This Exciting New Research Mean I Have to Change My Advice About Taking Aspirin? Second Opinion. Vol. XXV, No 9, September 2015

• Merino, J.L. et al. Is It Safe (and When) to Stop Oral Anticoagulation After Ablation for Atrial Fibirllation? Cardiovascular Drugs and Therapy. Sept. 07, 2021. https://link.springer.com/article/10.1007/s10557-021-07246-3

Return to FAQ Catheter Ablations
Last updated: Wednesday, October 13, 2021

(Video) Atrial Fibrillation Treatment: Hybrid Atrial Fibrillation (AF) Ablation

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How long do I need to take blood thinners after ablation? ›

After an ablation, people typically take a blood thinner for a minimum of two months, says Dr. Ellenbogen. Because of this, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin and Advil or Motrin (ibuprofen), may be limited in order to reduce the risk of bleeding.

Do you need to continue with blood thinners after an ablation? ›

Catheter ablation, which destroys a small area of heart tissue that's causing the problematic beats, is recommended for high-risk patients. Patients typically continue to take blood thinners, regardless of whether the ablation procedure was effective.

Can you stop taking blood thinners after cardiac ablation? ›

“This data shows that in certain patients with nonparoxysmal AF who no longer have recurring AF following catheter ablation as confirmed by routine monitoring and daily pulse checks, anticoagulation may be safely discontinued to minimize the risk for major bleeding,” said the study's senior author, David Callans, MD, ...

Can you live with AFib without blood thinners? ›

While patients who have elevated stroke risks may be able to manage symptoms of AFib — such as a racing heartbeat — with other medications or medical procedures, they will still need to take blood thinners to protect against stroke.

How long does it take for your heart to heal after AFib ablation? ›

The ablated (or destroyed) areas of tissue inside your heart may take up to eight weeks to heal. You may still have arrhythmias (irregular heartbeats) during the first few weeks after your ablation. During this time, you may need anti-arrhythmic medications or other treatment.

How long does it take nerves to heal after ablation? ›

It is possible the nerve will regrow through the burned lesion that was created by radiofrequency ablation. If the nerve regrows, it is usually 6-12 months after the procedure. Radiofrequency ablation is 70-80% effective in people who have successful nerve blocks.

Is it common to go in and out of AFib after ablation? ›

Recurrent AF after catheter ablation occurs in at least 20 to 40% of patients. Repeat ablation is primarily considered for those with symptomatic AF recurrences (often drug-refactory) occurring at least 3 months or more post-ablation.

When can I stop Eliquis after ablation? ›

Conclusion: In conclusion, discontinuation of oral anticoagulation 3 months after a successful AF ablation appears to be safe in highly selected closely monitored patients. Further randomized trials are warranted to assess the safety of discontinuing OACs after AF ablation.

Can you still go into AFib after an ablation? ›

Regardless of the monitoring device used, it is essential to remember that afib may still occur after the ablation. Many people experience some atrial fibrillation or atrial flutter after a catheter ablation due to inflammation of the heart tissue.

Do and don'ts after heart ablation? ›

After catheter ablation, you should avoid heavy lifting and strenuous exercise for at least three days. Talk with your provider about when it's safe to return to physical activity. After surgical ablation, you'll spend about a week in the hospital.

How long can you safely be off blood thinners? ›

Blood thinner treatment for PE is usually advised for at least 3-6 months. Your healthcare provider may advise a longer course depending on why you had the blood clot. Some people at high risk of blood clots may stay on blood thinner indefinitely.

How likely is a stroke after atrial fibrillation ablation? ›

These 19 studies1230 enrolled 4722 patients (2485 receiving ablation versus 2237 on optimal medical therapy alone; Table). The overall risk of stroke was very low and very similar in both the interventional and medical therapy groups (0.85% risk in the former versus 1.0% in the latter).

What can I take instead of blood thinners? ›

Natural blood thinners are substances that reduce the blood's ability to form clots.
Some foods and other substances that may act as natural blood thinners and help reduce the risk of clots include the following:
  • Turmeric. ...
  • Ginger. ...
  • Cayenne peppers. ...
  • Vitamin E. ...
  • Garlic. ...
  • Cassia cinnamon. ...
  • Ginkgo biloba.

What is the first drug of choice for atrial fibrillation? ›

Beta blockers and calcium channel blockers are the drugs of choice because they provide rapid rate control. These drugs are effective in reducing the heart rate at rest and during exercise in patients with atrial fibrillation.

How do I get off Eliquis safely? ›

Stopping Eliquis isn't known to cause withdrawal symptoms. You can stop taking Eliquis without tapering your dosage first. However, if you stop Eliquis sooner than your doctor recommends, you may have an increased risk of blood clots. Eliquis has a boxed warning for this side effect.

How long does it take to feel normal after an ablation? ›

It may take a few days to 2 weeks to recover. This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to feel better as quickly as possible.

What causes AFib to return after ablation? ›

In the setting of early recurrences after atrial fibrillation ablation, reconnection of one or more of the previously ablated pulmonary veins is thought to be the culprit and repeat ablations provided incremental benefit for rhythm control.

Can AFib get worse after ablation? ›

However, AF ablation frequently results in temporary increased atrial arrhythmias and worsened symptoms in the first three to six months after the procedure with reported incidence ranging from 1.2–40%.

Should I rest after ablation? ›

After the Procedure

After the catheter ablation, you will probably need to lie still for two to six hours to decrease the risk of bleeding. Medical staff members may apply pressure to the site where the catheter was inserted. Special machines will monitor your heart as you recover.

How long after ablation do you know if it worked? ›

Does ablation work straight away? You may still have symptoms, such as palpitations, in the weeks following the procedure. For some ablation techniques, you will need to wait three months to see if the treatment was successful.

Why am I so tired after my cardiac ablation? ›

Also, your heart rhythm may feel faster than usual for a period of time and you may feel tired as your heart and body need time to adjust. These symptoms will improve on their own over time.

Can ablation cause congestive heart failure? ›

Catheter ablation is an effective approach for managing patients with atrial fibrillation (AF) [1-7]. Currently, irrigation catheters are widely used in AF ablation. This causes volume overload during the procedure and occasionally causes heart failure after the procedure.

What percentage of heart ablations are successful? ›

When the procedure is repeated in patients who still have atrial fibrillation after the first procedure, the overall success rate is approximately 85-90 percent. Persistent atrial fibrillation can be eliminated in approximately 50 percent of patients with a single procedure.

What are the dangers of ablation for AFib? ›

Possible atrial fibrillation ablation risks include: Bleeding or infection at the site where the catheters were inserted. Blood vessel damage. Heart valve damage.

How long after stopping Eliquis does blood return to normal? ›

If you stop taking apixaban, the rate at which your blood clots will return to what it was before you started taking it, usually within a day or two of stopping. This means that you may be at increased risk of serious problems like stroke, heart attack, deep vein thrombosis or pulmonary embolism.

How long can a patient stay on Eliquis? ›

How long will I be on ELIQUIS? Your doctor will decide the duration of your treatment. After at least 6 months of treatment for DVT/PE, your doctor may ask you to continue on a lower dose of ELIQUIS to help reduce the risk of them happening again. How long one takes ELIQUIS generally varies from patient to patient.

How long should you take antiarrhythmic drugs after an ablation? ›

Antiarrhythmic drugs (amiodarone, tikosyn, propafenone, flecainide, sotalol, etc.) will be continued for a minimum of three months after the procedure. In many cases, antiarrhythmic drugs can be discontinued after this time period.

Can ablation stop AFib permanently? ›

Does Ablation Cure AFib? AFib may go away for a long time, but it can return. It's rare, but if you have persistent or chronic AFib, you might need a second ablation within 1 year. If you've had AFib for more than a year, you may need one or more treatments to fix the problem.

Does AFib cause extreme fatigue? ›

Fatigue or weakness

This lack of blood supply can cause fatigue, even when you're resting or being only slightly active. Everyone gets tired from time to time, but the fatigue that accompanies a heart condition like Afib is often described as: Constantly tired. Drained.

What are the restrictions after cardiac ablation? ›

Some people feel a little sore after the procedure. The soreness shouldn't last more than a week. Most people can return to their daily activities within a few days after having cardiac ablation. Avoid heavy lifting for about a week.

What is the downside of an ablation? ›

Pregnancy after ablation, while rare, carries risk of miscarriage and complications. Bleeding may still occur after ablation, a hysterectomy may be needed in the future. The procedure carries risks (e.g., infection, bleeding, damage to uterine wall or bowel).

How many days after ablation can I exercise? ›

About 3 to 4 days after your procedure, you can start to go for walks at a slow to medium pace. Don't walk if you have angina (chest pain) or shortness of breath. You can restart all of your regular exercise after 1 week (for example jogging, weightlifting or sports).

Can I drink caffeine after a cardiac ablation? ›

Remember, No Coffee After Heart Surgery!

“Coffee is not recommended right after any form of cardiac surgery, including heart valve surgery.”

Can I skip a day of blood thinners? ›

Never skip a dose, and never take a double dose. If you miss a dose, take it as soon as you remember. If you don't remember until the next day, call your doctor for instructions. If this happens when your doctor is not available, skip the missed dose and start again the next day.

What happens if you don't take blood thinners for a few days? ›

This could be life-threatening because stopping thinners could cause clots to form in the blood again.

How can you prevent a stroke after atrial fibrillation? ›

Shang-Chiun Lee with Mercy Clinic Cardiology has seven things you can do to help lower your risk of stroke while living with AFib:
  1. Get your AFib under control. ...
  2. Exercise. ...
  3. Maintain a healthy weight. ...
  4. Avoid alcohol. ...
  5. Don't smoke. ...
  6. Keep diabetes in check. ...
  7. Get quality sleep.

How many people with a fib have a stroke? ›

AFib causes about 1 in 7 strokes. Strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes. Strokes happen when blood flow to the brain is blocked by a blood clot or by fatty deposits called plaque in the blood vessel lining.

Do all AFib patients have strokes? ›

About one in three people with afib will have a stroke at some time. Those at greatest risk have other risk factors for a stroke, such as other forms of heart disease, high blood pressure, obesity, smoking, or high cholesterol. Some of those risk factors are controllable, which can help decrease the risk of a stroke.

What is the number one prescribed blood thinner? ›

Types of anticoagulants

The most commonly prescribed anticoagulant is warfarin.

What is the safest blood thinner medication? ›

A new study published in November 2022 in Annals of Internal Medicine found apibaxan to be the safest blood thinner among DOACs, including dabigatran, edoxaban and rivaroxaban. Apibaxan was associated with the lowest risk of gastrointestinal bleeding.

What should I avoid while taking metoprolol? ›

Because metoprolol is a beta-blocker, a type of drug known to increase potassium levels in the blood, you might want to be mindful of potassium-rich foods like meat, bananas, and sweet potatoes.

What aggravates atrial fibrillation? ›

Certain situations can trigger an episode of atrial fibrillation, including: drinking excessive amounts of alcohol, particularly binge drinking. being overweight (read about how to lose weight) drinking lots of caffeine, such as tea, coffee or energy drinks.

What is the safest AFib medication? ›

Of all antiarrhythmic agents, dofetilide and amiodarone have been proven safe in patients with heart failure.

Is fatigue a side effect of Eliquis? ›

Tiredness wasn't reported in clinical studies of Eliquis. However, tiredness can be a symptom of blood loss or anemia, which are possible side effects of Eliquis. If you have tiredness while taking Eliquis, talk with your doctor. They may check you for any symptoms of internal bleeding.

Can you take Eliquis for the rest of your life? ›

If you've experienced a blood clot, doctors may recommend that you continue taking anticoagulant medications for the rest of your life. This can reduce your risk of blood clots and stroke.

Does Eliquis make your hair fall out? ›

Commonly used anticoagulants that may cause hair loss include: Heparin. Warfarin (Coumadin) Apixaban (Eliquis)

Do you need to take blood thinners forever? ›

If you've experienced a blood clot, doctors may recommend that you continue taking anticoagulant medications for the rest of your life. This can reduce your risk of blood clots and stroke.

How often does AFIB return after ablation? ›

Although most arrhythmia recurrences typically occur in the first 6 months to 1 year after ablation,57 AF recurrences, after initially achieving long-term success, have been reported.

How long do you have to be off eliquis before ablation? ›

Patients usually take the blood thinners for a month before catheter ablation then stop taking the anticoagulant a few days before the procedure to reduce the risk for excessive bleeding during the surgical procedure.

How long should you be on blood thinners? ›

Clinical trials provide several recommendations for adults with blood clots. Adults with a first provoked blood clot should take blood thinners for 3-6 months. Adults with a first unprovoked blood clot generally should take blood thinner for 6-12 months.

What is the downside of taking Eliquis? ›

Common Eliquis side effects include nosebleeds, bleeding gums, bruising easily and bleeding that takes longer to stop. Internal bleeding is a rare serious side effect. Stopping Eliquis suddenly may increase the risk of blood clots. People with preexisting bleeding conditions shouldn't take Eliquis.

Can you ever stop taking Eliquis? ›

Stopping Eliquis isn't known to cause withdrawal symptoms. You can stop taking Eliquis without tapering your dosage first. However, if you stop Eliquis sooner than your doctor recommends, you may have an increased risk of blood clots. Eliquis has a boxed warning for this side effect.

Why is pantoprazole prescribed after ablation? ›

High doses of proton pump inhibitors (omeprazole or pantoprazole, 40 mg twice a day) for 30 days have been recommended to reduce the reflux of acid to the esophagus after ablation, independent of the findings of the esophageal temperature monitoring during the procedure.

What not to do while on blood thinners? ›

Because you are taking a blood thinner, you should try not to hurt yourself and cause bleeding. You need to be careful when you use knives, scissors, razors, or any sharp object that can make you bleed. You also need to avoid activities and sports that could cause injury. Swimming and walking are safe activities.

How long does 5mg of Eliquis stay in your system? ›

Apixaban begins to reduce blood clotting within a few hours after taking the first dose. If you stop taking apixaban, its effects on clotting begin to wear off within 24 hours for most people.

What is the truth about Eliquis? ›

Eliquis is considered a high-alert medicine, which means that it's safe as long as it's taken correctly. If mistreated, it can lead to many serious health risks, including stroke and severe bleeding. Therefore, people need to be extremely cautious when taking Eliquis.


1. Am I Still Taking Afib Medications After Ablation?
(Afib Patient Experience)
2. Cardioversion and Atrial Fibrillation Ablation
(Neurology Live)
3. Atrial Fibrillation and Catheter Ablation | NEJM
(NEJM Group)
4. Jacqueline's AFib and catheter ablation story
(Biosense Webster)
5. How to reduce the risk of AF coming back after an ablation
(York Cardiology)
6. AFib Ablation: A Step By Step Consultation
(Doctor AFib)


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