Blood thinners , pacemaker change and Surgery

Dear members,

Please could I ask you your kind advise and/or opinion? My dad who recenlty started having AF is now taking Eliquis as blood thinner and soon to get his PM battery change. He is 70. He was also recently diagnosed with Groin Hernia (moderate) and is recommended to have surgery. Since now he is on blood thinners his EP recommends getting both surgeries done consecutively as he needs to come off blood thinners and while without blood thinners. The Surgeon who's doing Hernia surgery is ok with this and says he can do it the next day under local anasthesia. He also said he will have to turn off the PM for a short time during the surgery. I am a bit concerned on the following and I really value your comments.

1. Would you recommend that it is better to let him recover after the PM change surgery and wait a few months before the Hernia surgery as it doesn't seem needed immedietly. I am woriied that too many interventions at once may be hard on the body to recover.

2. Do coming off blood thinners have a big risk if done at two times? For instance if we have the two surgeries about 6 months apart but considering he has AF.

3. How risky is having the PM turned off dring a surgery - he uses PM for VP for at least 50%. If we are to do this immedietly after he gets the PM change, would it be more risky? 

I am thankful to your comments and advise. 





Blood thinners

by AgentX86 - 2020-03-12 08:27:01

1. How critical is the PM battery replacement? If it's not critical, I'd tend to put that off beforeputtingthe herniasurgeryoff. If it is, I'd follow the advice of the professionals. It's also worth asking about bridging the Eliquis fir a couple of days with heparin. Heparin has a very short half-life in the body and can essentially be turned on and off in a very short time. Eliquis' half-life is pretty short to, something like 18hrs (which is why it has to be taken twice a day), so you're unprotected for a day or two,  at the most. I've had ablations where I only skipped a dose the night before and that morning. You can suggest alternatives but mostly to educate yourself.

2. Two, six months apart is twice the risk, as far as anticoagulants go. It's stil not much in most cases (there are some procedures that greatly increase the risk of clots). There is no reason to wait that long, in any case.

3. Turning the pacemaker off during surgery isn't a big deal. If necessary  they can use an external pacemaker. They just want more control than his pacemaker will give. It's also likely that when they say "turn it off" they mean "put it in safe mode". Ask questions .

Ask questions until you're happy with the answers. They're not likely to change their procedures but you'll feel better about it.

get it over with

by Tracey_E - 2020-03-12 10:32:47

Personally, I'd want to have it all done and over with and only deal with coming off the eliquis once, but that's just me. What's your dad's opinion?

The pacer replacement is a piece of cake, very minimal soreness after. I'm younger than your dad, but I'm on my 5th device. I'm usually home fixing my own lunch after replacement and twice I left for vacation less than a week later. Most of the restrictions after the first placement are due to new leads, most of the soreness was from making the pocket to hold the pacer. This time it's all scar tissue and healing is just the incision. 

They won't turn the pacer all the way off, only limit function. 

Thank you very much

by CharmJaya - 2020-03-13 07:49:06

Thank you very much for sharing your views on this. The battery change is needed imminently with about 5% remaining. But from what the surgeon said (not knowing about the need for PM change at first)  hernia can wait if we need to as it is still at the beginning. I mean he did not rushed to go for surgery. However when hernia was mentioned to EP he suggested it would be better to get both done in a row. Dad thinks that it is ok but it worries me him going under local anaesthesia and going on surgery while out of blood thinners if at all and in a row. I am afraid of how any AF effects can be kept under controlled without blood thinners. That is why I thought whether to get the PM change now and in about six month get the hernia done but I understand it is basically only trying to delay it and then have to come off blood thinners twice. Do you think this is more risky and has lesser benefit over getting them done consecutively?

Also both doctors suggested to come off Eliquis 5 days before but I don't know the reason behind which I will question him. 

I am grateful to hear your views, and hear your experience if anyone underwent hernia surgery while they were on blood thinners for AF and how was their recovery.

Thank you very much again. 

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