Suspending anticoagulation without bridging for needle aspiration/biopsy?

[MurmurSinceForever]

Hi all, I find myself in need of your collective and vast experience. Has anyone needed a fine needle aspiration or needle biopsy while on anticoagulation therapy? Did you suspend or not suspend, bridge or not bridge. Today I was advised they would like to suspend warfarin for a week (5days) prior to the procedure, without bridging ( using heparin). The surgeon is checking with my family GP where my INR clinic is run before he schedules the test but that was his initial suggestion. My internet search convinced me that both suspending and not suspending was correct. So I am looking for real life experience if possible.

Also, while I am asking, did anyone require or not require a loading does of antibiotics for such a procedure. This is for a lump in my breast, suspected breast cyst, and the aspiration is for confirmation it is benign.

Thanks to anyone who can share similar experiences.

St. Jude's mechanical aortic valve, INR range 2.5 - 3.5

 

[pellicle]

Hi

there was a thread here recently in which I did a bit of digging around and found that indeed current practice is to determine that removal of anticoagulation in "low risk" patients for about that period is generally accepted practice.

Here is that thread
http://www.valvereplacement.org/foru...d-i-be-worried

I understood without other indicators that the St Judes mechanical in Aortic is a "low risk" reason to be on anticoagulation.

Also, from what I've read (unrelated to your question) that 2.5 - 3.5 is now a little higher than current practice. Target of 2.5 with a little wiggle around either side of that is now normal for St Jude bileaflet in aortic position (I'll see if I can fish out a reference for that).

got one:
http://circ.ahajournals.org/content/94/9/2055.full

Thus, the AREVA Study shows that the low-risk patient with a St Jude or Omnicarbon mechanical prosthetic aortic valve replacement in normal sinus rhythm and a left atrial diameter ≤50 mm is the special case for lower-dose oral anticoagulation to an INR of 2.0 to 3.0.

https://www.mnhospitals.org/Portals/0/Documents/ptsafety/ade/warfarin-INR-range-duration.pdf

suggests 2.0 - 3.0 without other mitigating risks

some others

http://www.globalrph.com/warfarin_inr_targets.htm

http://www.ncbi.nlm.nih.gov/pubmed/15383481

For patients with a St. Jude Medical (St. Paul, MN) bileaflet valve in the aortic position, we recommend a target INR of 2.5 (range, 2.0 to 3.0)

http://www.ncbi.nlm.nih.gov/pubmed/11157651

Levels of oral anticoagulants that prolong the INR to 2.0 to 3.0 appear satisfactory for patients with St. Jude Medical bileaflet and Medtronic-Hall tilting disk mechanical valves in the aortic position, provided they are in sinus rhythm and the left atrium is not enlarged

 

[MurmurSinceForever]

Thank you pellicle, I knew I could count on you! I had read that thread regarding the suspension of warfarin for up to 5 days and totally forgot about it when I was faced with the discussion with the surgeon yesterday. I admit it threw me a bit. So thank you for referring me back. Ok, so I feel confident that I can do what is asked, now I am doubting the necessity of it for a, in my mind, simple needle poke. Perhaps I am not completely understanding the procedure. What are the chances? Ha.

Thanks also for the INR range discussion. In fact my INR clinic brought this up when I started, and they agree with you. I am still following the AVR surgeon's advice who is going by what the valve manufacturer (St. Jude's) said. So far I haven't given over to the 2.0 - 3.0 range but am comforted by it anytime my INR reads below 2.5. So I guess I am half way there, 2.0-3.5, and judging by my mood at test time, happiest between 2.5-3.0.

 

[MurmurSinceForever]

I received a followup call from the breast clinic and after the surgeon consulted with my cardiologist, the plan has been settled without the need for suspension of the warfarin or the need for prophylactic antibiotics without compromise to the testing I require. Sounds good to me. The nurse also told me that for my future reference, my cardiologist would not advise suspension of warfarin without bridging for any reason. Hmmm. Interesting. I am glad that I spoke up to the breast surgeon, who I think over reacted a bit, and I am glad my cardiologist is so responsive to consultation with other health professionals. I feel very well taken care of.

 

[pellicle]

So far I haven't given over to the 2.0 - 3.0 range but am comforted by it anytime my INR reads below 2.5. So I guess I am half way there, 2.0-3.5, and judging by my mood at test time, happiest between 2.5-3.0.

I agree with your view. As I steer towards the 2.5 in the main I am happy being between 2.5 and 3 , unconcerned around 3 or towards 2 , and do something about it either side of that