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Q. Are blood thinners needed after the Cox-maze procedure for atrial fibrillation?

Answered by
Dr. Tanmai Yermal (jain)
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 26, 2021

Hello doctor,

I have asymptomatic paroxysmal atrial fibrillation.I had my left atrial appendage excised in the Cox-maze procedure. Should I be on blood thinners?

#

Hi,

Welcome to icliniq.com.

I have gone through your query. I need to know some more details about your case. What is your age? When was the Cox-maze procedure done along with appendage excision? What was the indication of that procedure at that time? Do you have any other prosthetic material in situ, like any prosthetic heart valve, etc.? Do you have any contraindications for blood thinners? Do you have any recent echo reports to share? Do you have documented paroxysmal atrial fibrillation episode?

Kindly get back with the above details for further discussion and management.

Thank you.

Take care.

Hello doctor,

My age is 89. The Cox-maze procedure was done many years before, it was a successful procedure. No other prosthetics. I have high calcium in arteries. The echo is coming on Tuesday, the Cardiologist has taken three electrocardiograms. My mobile shows in sync and out several times daily.

#

Hi,

Welcome back to icliniq.com.

It would have been better if you can share those ECGs and your kardia (mobile) recordings, if available, just to make sure that you have paroxysmal atrial fibrillation.

As planned with your cardiologist, kindly get an echo done to look for left atrial size and SEC (spontaneous echo contrast), if any, and also for your heart function.

And what is your kidney function test report or serum creatinine report? Do you have diabetes or hypertension? Any history of bleeding in the past?

All these questions or detailed history is required just because of your age factor. As you will be at a high risk of bleeding if started on oral anticoagulant medication (blood thinner) unless it is a must.

Thank you.

Hello doctor,

I will send ECGs shortly. Kidneys and creatine levels are within the normal ranges. I do not have diabetes, just borderline blood pressure. I do not have any history of bleeding.

#

Hi,

Welcome back to icliniq.com.

Your kidney reports (attachments removed to protect the patient's identity) are too old to comment upon. If you give this year reports then it is acceptable. Anyways, you please attach your ECGs and echo report as well. So that we can come to a decision of either starting or deffering blood thinners. Over all you do not look to have a high risk of bleeding except for your age. But I will not advice to take it unless you have a clear cut evidence to start it. So please get your ECGs, other recordings and echo report to decide the management. Thank you.

Take care.

Hello doctor,

Sorry, I will get this year's report.

#

Hi,

Welcome back to icliniq.com.

Anyways, I have seen your ECGs, which have evidence of AF (atrial fibrillation). Considering your age, entire history, and reports, I feel you have to be on blood thinners (either antiplatelets or newer anticoagulants). Blood thinners will reduce the risk of stroke in you, whereas they will carry a mild to moderate risk of bleeding due to your age.

But the final decision can be taken once you get your echo done.

Kindly get back with your echo report once you get it done from your Cardiologist.

Thank you.

Take care.

Hello doctor,

Thanks for your response.

#

Hi,

Welcome back to icliniq.com.

LAA (left atrial appendage) closure definitely reduces the risk of stroke, but it does not make it 0%. In such cases, we go with other parameters like left atrial size, LV (left ventricle) function, structural heart disease, valvular functions, etc., and then decide on the need for blood thinners. We even need to take into consideration the bleeding risk before starting the medications. Anyways, do not worry. Your risk of embolic stroke is not very high, and also, the bleeding risk is not high.

Let us come up with the final decision after 2D ECHO.

Thank you.

Hello doctor,

I have attached the file.

#

Hello,

Welcome back to icliniq.com.

I have gone through your attached document (attachments removed to protect the patient's identity).

So you have undergone bypass surgery as well, along with maze procedure. So anyway, you have to be on blood thinners (antiplatelets) for CABG (coronary artery bypass graft surgery).

The only question is whether to put you on stronger blood thinners like newer oral anticoagulants. And that we will decide after getting your Echo done.

So along with your Echo report, please send the list of current medications that you are regularly taking. Especially, Aspirin how much dose are you taking?

Take care.

See you again with the Echo report.

Thank you.

Hello doctor,

I am taking Aspirin 75 mg, Repatha (Evolocumab) injection every two weeks, Lisinopril 10 mg three to four times a week. The CABG was incidental to the maze. A branch artery was partially blocked.

#

Hi,

Welcome back to icliniq.com.

Aspirin 75 mg is the right dose you should be on. In your summary you have sent in the previous attachment showed 325 mg of Aspirin as your current medications, which will be so high. So just asked you again to confirm the dose. For the time being you please continue the same dose of Aspirin 75 mg once a day along with your other medications till you get your echo done. Also, if possible, get 24-hour Holter done and lipid profile, serum creatinine if it is not done recently.

Thank you.

Hello doctor,

Last month, I had a Holter monitor on for 30 days. I have attached the Lab Tests.

#

Hi,

Welcome back to icliniq.com.

Kindly attach the Holter report and also the other reports done.

You have just sent the list of lab tests done.

Also, send the Holter report that must have been given with a bunch of ECGs.


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