Consult cardiologist about blood thinner

Dear Dr. Roach: I would very much like to stop using warfarin. I underwent a successful ablation surgery (maze procedure) to correct my atrial fibrillation, and my valve replacement surgeries also were successful (mitral and aortic). At that time, they also did a closure of the left atrial appendage where the blood pools and possibly clots. It’s been a year on the blood thinner, but I would like to stop. Do you think that would be safe? — G.M.

You have had a lot done. Let me explain what you went through before answering the question.

Atrial fibrillation is a common rhythm disturbance, where the normal, regular rhythm of the heart is disrupted by chaotic electrical activity in the upper chambers of the heart. This leads to an irregular, sometimes too fast, heartbeat. The chaotic rhythm lessens the ventricles’ ability to fill up with blood, which can lead to decreased output and an increase in the risk of blood clotting. This increases the risk of stroke. It’s the stroke risk that should concern you most.

The electrical abnormalities of atrial fibrillation can be treated with anti-arrhythmic drugs or with surgery. The maze procedure is about 60 percent effective in restoring normal heart rhythm. At the time of the maze procedure, the left atrial appendage is normally closed. In people who have been successfully treated and have remained in normal heart rhythm for at least three months, with no recurrence of atrial fibrillation, and who have had the left atrial appendage closed, anticoagulation can be stopped, particularly in people who are not good candidates for long-term oral anticoagulants, such as warfarin, due to bleeding risk or some other reason. So, it’s entirely reasonable to ask your cardiologist about it. Your cardiologist knows you much better than I do.