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Is Temporary Withdrawal Of Xarelto Advisable Before An Abdominoplasty?
Question: My wife was planning having surgery to remove excess skin in the stomach area. All of her doctors have approved her for the operation except for her cardiologist, who has said that she should not go off of xarelto because she had had atria fibrillation less than 30 days prior to her operation. He said that this 30 day period is the protocol with taking xarelto. Would you agree?
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your wife medical history and would explain that it is true that atrial fibrillation is considered a dangerous clinical condition regarding increased risk of thrombotic complications (thrombus that may be created inside atrial chambers, may potentially spread be means of blood flow to several organ sites like brain, lung, limbs, leading to stroke, pulmonary ischemia and gangrene respectively, etc.).
That is why your cardiologist is right about the need for continuous anti-coagulation with Xarelto, especially considering the fact that your wife is experiencing repeated episodes of atrial fibrillation.
Also, three to four weeks of continuous anti-coagulation is at least necessary after conversion of atrial fibrillation to normal sinus rhythm, because although the rhythm has returned to normal sinus, the atrial muscle still is in a stunning condition and doesn't exert efficient contractions.
This situation may be a predisposition for thrombus formation just the same as when the individual is in atrial fibrillation.
But from the other side, if the atrial fibrillation has been promptly treated, and has not lasted for a long time up to its conversion to normal sinus rhythm, the probability of a stunning myocardium is less likely and the risk of thrombosis is quite small.
So, coming to your wife's clinical case, I would assure you that a 24-48 hours of Xarelto withdrawal, followed by surgery and 24 hours after restarting Xarelto or any other anti-coagulants, may be performed without any obvious risk for thrombosis.
Another alternative strategy in order to be more secure for the atrial condition is to perform a trans-esophageal echocardiography before, stop Xarelto and then proceed safely to surgery. After that Xarelto may be restarted 1-2 days after surgery.
Both the above alternatives are quite acceptable.
You should discuss with her doctor on the above issues.
Hope to have been helpful!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your wife medical history and would explain that it is true that atrial fibrillation is considered a dangerous clinical condition regarding increased risk of thrombotic complications (thrombus that may be created inside atrial chambers, may potentially spread be means of blood flow to several organ sites like brain, lung, limbs, leading to stroke, pulmonary ischemia and gangrene respectively, etc.).
That is why your cardiologist is right about the need for continuous anti-coagulation with Xarelto, especially considering the fact that your wife is experiencing repeated episodes of atrial fibrillation.
Also, three to four weeks of continuous anti-coagulation is at least necessary after conversion of atrial fibrillation to normal sinus rhythm, because although the rhythm has returned to normal sinus, the atrial muscle still is in a stunning condition and doesn't exert efficient contractions.
This situation may be a predisposition for thrombus formation just the same as when the individual is in atrial fibrillation.
But from the other side, if the atrial fibrillation has been promptly treated, and has not lasted for a long time up to its conversion to normal sinus rhythm, the probability of a stunning myocardium is less likely and the risk of thrombosis is quite small.
So, coming to your wife's clinical case, I would assure you that a 24-48 hours of Xarelto withdrawal, followed by surgery and 24 hours after restarting Xarelto or any other anti-coagulants, may be performed without any obvious risk for thrombosis.
Another alternative strategy in order to be more secure for the atrial condition is to perform a trans-esophageal echocardiography before, stop Xarelto and then proceed safely to surgery. After that Xarelto may be restarted 1-2 days after surgery.
Both the above alternatives are quite acceptable.
You should discuss with her doctor on the above issues.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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