cuts on warfarin

[pellicle]

One of the things that seems to involve concern (can I say verging on hysteria?) is what happens if you get a cut.

Well today while fitting the ducting for my "room to room air ducting" I managed to fail to secure the safety on the ladder, it fell apart and I landed holding it and lacerated my thumb.

I applied pressure and walked to the local clinic (swearing at my stupidity) where they cleaned and dressed if for me.

This is just before stitching (and before the local). During the procedure the I asked the Dr (funny young guy) if this was bleeding more than "expected" ... he said, no, its bleeding less than expected. I'll report my INR tomorrow because I test on Saturday and today is Friday (wouldn't you know it).

UPDATED: INR = 2.8

So with some stitches in place its all bandaged up now and I'll get the dressing changed in a couple of days (probably).

I'm posting this because I want to be able to refer to it when someone else says "I can't go on warfarin in case I cut myself"

This is of course not news to those of us who've been on warfarin for a while.

 

[Warrick]

I got the flu jab yesterday (had it every year for years) and the nurse at first refused because I said I was on warfarin when asked....
Then I said my INR was 2.3 last week.. “oh ok youv got a well managed INR”, then I got the stab.
Do they honestly think a needle prick will result in uncontrolled bleeding FFS

 

[pellicle]

Do they honestly think a needle prick will result in uncontrolled bleeding FFS

Probably afraid you'd get a clot.

 

[cldlhd]

One of the things that seems to involve concern (can I say verging on hysteria?) is what happens if you get a cut.

Well today while fitting the ducting for my "room to room air ducting" I managed to fail to secure the safety on the ladder, it fell apart and I landed holding it and lacerated my thumb.

I applied pressure and walked to the local clinic (swearing at my stupidity) where they cleaned and dressed if for me.

View attachment 887863

This is just before stitching (and before the local). During the procedure the I asked the Dr (funny young guy) if this was bleeding more than "expected" ... he said, no, its bleeding less than expected. I'll report my INR tomorrow because I test on Saturday and today is Friday (wouldn't you know it).

So with some stitches in place its all bandaged up now and I'll get the dressing changed in a couple of days (probably).

I'm posting this because I want to be able to refer to it when someone else says "I can't go on warfarin in case I cut myself"

This is of course not news to those of us who've been on warfarin for a while.

That's a nice slice.... What are you trying to out do me? Had my stitches out last week, All healed up just looking a little bit ugly yet...

 

[ATHENS1964]

Because of my profession, I talk to many dentists, I have asked many people how the extraction of teeth in humans is in warfarin and most of them answered that they do not bridge with heparin injections. The bleeding is controlled and almost always like a normal patient. Rarely do they need to put a hemostatic sponge that is left in the cavity and absorbed.
Only in cases such asmaxillofacial surgery implants require heparin .
They attach more importance to protection against endocarditis than bleeding.

 

[dick0236]

Because of my profession, I talk to many dentists, I have asked many people how the extraction of teeth in humans is in warfarin and most of them answered that they do not bridge with heparin injections. The bleeding is controlled and almost always like a normal patient. Rarely do they need to put a hemostatic sponge that is left in the cavity and absorbed.
Only in cases such asmaxillofacial surgery implants require heparin .
They attach more importance to protection against endocarditis than bleeding.

This has been my experience as well. I have seen a number of dentists since being on warfarin. I have never had to bridge or hold warfarin dosing. I have routinely taken the anti-biotic Amoxicillin to protect against infection but that is all.

 

[Chuck C]

I got the flu jab yesterday (had it every year for years) and the nurse at first refused because I said I was on warfarin when asked....
Then I said my INR was 2.3 last week.. “oh ok youv got a well managed INR”, then I got the stab.
Do they honestly think a needle prick will result in uncontrolled bleeding FFS

This meme is going to come in handy,

 

[Chuck C]

They attach more importance to protection against endocarditis than bleeding.

I expect this is the far greater risk at the dental office. I would imagine it should be a concern with cuts we get around the house or in the garden as well.

I've been cutting down a number of small trees in my yard recently- always would wear shorts in the past. Would get a few scrapes usually. After my first day of cutting and processing, I noticed that the small scrapes on my legs that I picked up bled more than before surgery. This is totally as one would expect when on warfarin. I decided going forward I would always wear pants in doing such work, not for fear of bleeding to death from a small scrape, but out of the possibility of bacteria entering the wound leading to endocarditis. I imagine the likelihood is very small with each scrape, but over the course of years and potentially hundreds of little scrapes perhaps a very small likelihood becomes unacceptably high when multiplied many times over. No point in taking the risk, so pants it is going forward.

 

[pellicle]

but out of the possibility of bacteria entering the wound leading to endocarditis.

Extremely unlikely

but over the course of years and potentially hundreds of little scrapes perhaps a very small likelihood

Remains the same, very unlikely.

A coin toss is the same likelihood no as in several years.

There is a huge difference between a mouth filled with a plethora of opportunistic pathogens very close to main blood supply routes and extremities like lower legs

 

[cldlhd]

Extremely unlikely


Remains the same, very unlikely.

A coin toss is the same likelihood no as in several years.

There is a huge difference between a myouth filled with a plethora of opportunistic pathogens very close to main blood supply routes and extremities like lower legs

Assuming you know more than me about the subject, which is pretty likely, it's not a case of you get a little bit of bacteria in there today and it pretty much stays put and maybe 8 months later you get a little more etcetera. Basically if you get an endocarditis infection it will likely grow until it's a problem I believe? I know that's not what Chuck is getting at that he's basically saying sooner or later you're allowed to get a bad outcome with a cut. But what I'm curious about is I have read various things claiming that the graft that replaces the aorta eventually gets recoded by the endothelia and then is no more likely to become infected than anybody else's? Or is Chuck referring more specifically to the mechanical valve itself?

 

[pellicle]

it's not a case of you get a little bit of bacteria in there today and it pretty much stays put and maybe 8 months later you get a little more etcetera.

correct .. its not.

bacteria do not have sleeper cells and so will be quickly dispatched by the immune system well before getting far or ramp up quickly as they start to become sessile and grow. This is the reason why most cuts even if they do get "infected" are not properly called infected but are called by pathologists "colonised"

Basically if you get an endocarditis infection it will likely grow until it's a problem I believe?

endo is very uncommon for a start, and requires a bacteria which is comfortable in living in and on you and is able to live both with and without oxygen. These are very uncommon in the sorts of cuts you get gardening.

But what I'm curious about is I have read various things claiming that the graft that replaces the aorta eventually gets recoded by the endothelia and then is no more likely to become infected than anybody else's?

ok, a few things here: The body is at most risk before endothelialization occurs (both on the graft and in and around the stitching ring. Just like when you get stitched to hold a cut together its soon the case that the stitches play no role in holding it together. Endothelialization is a covering of the foreign surface by cells. This is not a direct replacement of what tissue was there (for there was none) and in particular is not as smooth and "foot hold free" as the inside of the heart chamber or vascular walls. Thus giving a bacteria that is floating in the blood a chance to land on the right spot and become vegatative. When they are floating (planktonic) they behave differently to when they are sessile (vegatative).

To my understanding the main issue with "pre-endothelization" period of a graft is the chance for thromboembolism and is the same reason why its now standard procedure to give tissue prosthetic valve patients warfarin for the first 3 months (while endothelization occurs on the valve leaflets too).

relevant readings
https://www.ahajournals.org/doi/full/10.1161/01.cir.95.2.438
https://www.cedars-sinai.org/health...onditions/b/bacterial-endocarditis-adult.html

 

[cldlhd]

correct .. its not.

bacteria do not have sleeper cells and so will be quickly dispatched by the immune system well before getting far or ramp up quickly as they start to become sessile and grow. This is the reason why most cuts even if they do get "infected" are not properly called infected but are called by pathologists "colonised"



endo is very uncommon for a start, and requires a bacteria which is comfortable in living in and on you and is able to live both with and without oxygen. These are very uncommon in the sorts of cuts you get gardening.



ok, a few things here: The body is at most risk before endothelialization occurs (both on the graft and in and around the stitching ring. Just like when you get stitched to hold a cut together its soon the case that the stitches play no role in holding it together. Endothelialization is a covering of the foreign surface by cells. This is not a direct replacement of what tissue was there (for there was none) and in particular is not as smooth and "foot hold free" as the inside of the heart chamber or vascular walls. Thus giving a bacteria that is floating in the blood a chance to land on the right spot and become vegatative. When they are floating (planktonic) they behave differently to when they are sessile (vegatative).

To my understanding the main issue with "pre-endothelization" period of a graft is the chance for thromboembolism and is the same reason why its now standard procedure to give tissue prosthetic valve patients warfarin for the first 3 months (while endothelization occurs on the valve leaflets too).

relevant readings
https://www.ahajournals.org/doi/full/10.1161/01.cir.95.2.438
https://www.cedars-sinai.org/health...onditions/b/bacterial-endocarditis-adult.html

I figured it probably wouldn't be quite as slick as the original... But still good to hear It's not exactly like 180 grit. I assume that after 6 years whatever recoating is going to take place has already happened on my end. I'm wondering how much the scar tissue on my original valve makes me more susceptible. To be honest before my diagnosis I wasn't really even familiar with endocarditis and right after my surgery I was pretty paranoid about it for a bit but I kind of let that go. I keep my teeth clean, hit them with the ol' Listerine....

 

[pellicle]

keep my teeth clean, hit them with the ol' Listerine....

and don't forget regular (and proper technique) flossing
https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/dental-floss/faq-20058112

 

[Chuck C]

Extremely unlikely

Good to know. It makes perfect sense that the greatest risk would be the mouth route, given the high level of bacteria in the mouth and the frequent open wounds often occurring at the dental office. I figured the risk of bacterial infection from a cut or scratch was low, but thought it best to be especially careful especially in the first few months after surgery given the potential susceptibility of the healing tissues to host bacterial colonies. If my surgeon recommends no dental procedures for 6 months following surgery, I figured best to be extra cautious with potential bacterial entry points. But, it sounds like the type of bacteria associated with endocarditis is probably extremely unlikely to enter via a cut. The mouth on the other hand, different story, as you noted.

 

[Chuck C]

Or is Chuck referring more specifically to the mechanical valve itself?

I was thinking more about my valve as a point of risk for endocarditis, as this is what I have found discussed in the literature. In particular in the months following surgery, as I believe the healing suture is a place where bacteria can find a happy home.
But, you bring up a good point about the dacron sleeve. I have not heard of this as a risk factor before.

 

[pellicle]

It makes perfect sense that the greatest risk would be the mouth route, given the high level of bacteria in the mouth and the frequent open wounds often occurring at the dental office. I

not to mention that the whole thing is part of your digestive track and lined with blood vessels which will take whatever goes through direct into the blood stream. Meanwhile the skin is designed to keep infections out (and the blood pressure works towards that too).

If my surgeon recommends no dental procedures for 6 months following surgery, I figured best to be extra cautious with potential bacterial entry points. But, it sounds like the type of bacteria associated with endocarditis is probably extremely unlikely to enter via a cut.

Yes, that's my view at least.

Of course if you were getting heaps of scratches / abrasions and wading around in mud contaminated with grey water that would be different.

 

[user 16827]

Assuming you know more than me about the subject

I myself find this is usually the case

 

[pellicle]

I myself find this is usually the case

that's only because I don't talk about stuff I know nothing about. And we haven't talked about your field yet.

 

[Chuck C]

Of course if you were getting heaps of scratches / abrasions and wading around in mud contaminated with grey water that would be different.

So, perhaps it is a bad idea to enter a reality show in which you spend 60 days naked living next to muddy bacteria filled swamp? Cuts and scrapes would be often and likely to get infected by the muddy swamp..........or worse...........you might lacerate your scrotum and then fall into said muddy swamp water.
Yes, that happened. I'm going to put that on my list of things not to do with a prosthetic valve

First minute of clip below:

 

[cldlhd]

not to mention that the whole thing is part of your digestive track and lined with blood vessels which will take whatever goes through direct into the blood stream. Meanwhile the skin is designed to keep infections out (and the blood pressure works towards that too).




Yes, that's my view at least.

Of course if you were getting heaps of scratches / abrasions and wading around in mud contaminated with grey water that would be different.

Hmmm so I guess working for a water AND sewer authority might not be the best idea?