Warfarin, Bladder Stones and TURP (Transurethral resection of the prostate)

[tom in MO]

I have a bladder stone that needs to be removed and at the same time they want to "sculpt" my prostate with a TURP procedure to help me from getting more difficulties. I have been told that I need to be off warfarin with a bridge of Lovenex or Heparin for both stone removal and the TURP. The TURP procedure has some risk of bleeding, but my specific type is a bipolar TURP which uses a two electrode system with a plasma, thus resulting in less bleeding.

So I just would like to know anyone else's experience with bladder stone remove and/or TURP while on warfarin therapy. What type of bridge, how long was your hospital stay, any complications related to anti-coagulation therapy, etc....I have a St. Jude, mechanical, aortic valve with an INR range of 2-2.5.

Thanks,
Tom

 

[Superman]

I have a bladder stone that needs to be removed and at the same time they want to "sculpt" my prostate with a TURP procedure to help me from getting more difficulties. I have been told that I need to be off warfarin with a bridge of Lovenex or Heparin for both stone removal and the TURP. The TURP procedure has some risk of bleeding, but my specific type is a bipolar TURP which uses a two electrode system with a plasma, thus resulting in less bleeding.

So I just would like to know anyone else's experience with bladder stone remove and/or TURP while on warfarin therapy. What type of bridge, how long was your hospital stay, any complications related to anti-coagulation therapy, etc....I have a St. Jude, mechanical, aortic valve with an INR range of 2-2.5.

Thanks,
Tom

Had my gallbladder and appendix removed a couple years ago. Bridge was a couple days prior (I think), then they started warfarin up right away after the procedure. My only overnights were prior to surgery, because my gallstones had me doubled over in pain and were sending my bilirubin levels through the roof. Reminded me of "A Christmas Story", "He had yellow eyes! I swear! Yellow eyes!" Seem to recall driving myself to ER after work on a Wednesday and finally got the procedure Saturday morning? Went home either same or next day. Don't recall exactly.

Also had to bridge with lovenox two other times. Once for my second OHS and once to make sure we stopped at five kids. In both cases, the bridging was an additional inconvenience but not that significant relative to the actual thing being done.

 

[tom in MO]

Thanks Superman!

 

[tom in MO]

I was pretty surprised to get no specific responses. This is a common procedure.

So, to help those in the future, I will tell you my experience. I am pre-op, with a St. Jude valve at 2-2.5 INR range, my urologist wanted me to drop warfarin and aspirin for 5 days including the day of surgery. My cardiologist decided to keep me on aspirin but take me off warfarin for 5 days. My cardiologist stated I need to check my INR 3 days before I go off the warfarin so they can make any needed last minute changes. My cardiologist said the St. Jude valve is robust and relatively clot-free, so I did not need a bridging procedure. My urologist agreed to the slightly different approach.

 

[Superman]

Interesting. Neither the urologist (for the vasectomy) or the surgeon for the gallbladder would consider moving forward without bridging. I had a heck of a time getting them to allow the procedure without accepting donor plasma afterward.

My urologist would not do anything until I was below 2.0 INR. Did your surgeon give you a number, or just 5 days? "Relatively" clot-free - sure - but it just takes one. Okay - Dumb and Dumber just popped into my head. One of the main characters was wearing a bullet proof vest in the last scene. "What if he shot him in the face?" "It's a chance we were willing to take."

 

[tom in MO]

My urologist didn't tell me I had to meet a target INR. His nurse just stated I needed to check my INR right before surgery.

My urologist didn't give an opinion bridging other than to say it was a possible route dependent upon my cardiologist.

The "relatively clot-free" comment is my interpretation of the message and came second hand from the nurse. The gist of it was she said the cardiologist indicated with this procedure and my valve type you don't need bridging." The way I understand the mechanical valve is that it destroys platelets which can form clots but the warfarin keeps the clots from getting too big. I'm probably mistaken on the details

 

[Protimenow]

I'm not sure I can help a lot here, but I've had some minor procedures that required an INR near 1.0. I don't recall stopping five days before surgery - I think that it was more like 3. As far as bridging goes, Lovenox is effective for about 12 hours. If your INR is in 'danger' range, Lovenox will prevent clot formation. If I recall, I stopped the Lovenox the night before my cardiac catheterization, and resumed it for a day or two after the procedure. I also started Warfarin not long after the procedure.

I have multiple meters, and use the Coag-Sense. When my INR was in range following the procedure, I discontinued the Lovenox.

As far as valves go, I also have a St. Judes - but it's an older model (from 1991). It's a valve that deserves considerable respect. A few years ago, I put blind trust into an InRatio - the 2.6 it was telling me was a 1.7 at the hospital when I went in with a TIA. Today, I test weekly (sometimes somewhat less often) but get a blood draw every month or two just to keep my doctor happy and to validate that lab and meter results are close to each other.

One more thing - a study by Duke University Clinic a few years ago found that a few days without warfarin shouldn't cause much risk of stroke. If you miss a day or two, you'll probably be okay. If you've got a newer valve that has lower risk of clot formation, the risk of missing a dose is probably even lower.

If you have a meter, bridging when your INR drops below a value that your doctor wants you to hit, and then bridging until surgery is probably the best way to manage your INR.