Anti-Coagulation Mgmt Before and After Surgery

[ALCapshaw2]

OK fellow anticoagulated patients, I need to know how / who managed your anticoagulation before and after surgery (for those who have had surgery AFTER being put on Coumadin / Warfarin).

As I have memtioned in responses to other posts, I'm facing OHS#3 to replace my Mitral Valve this time. Standardized instructions advised patients who take Aspirin, Coumadin, or Plavix to discontinue those medications 4 days prior to surgery. I was surprised that there was NO MENTION of Bridging Therapy (which will be the subject of tomorrow's telephone call to the surgeon's office!).

Has anyone had surgery where they were OFF Coumadin for 4 days before (and ??? days after) their surgery without any Lovenox or Heparing Bridging?

'AL Capshaw'

 

[LUVMyBirman]

Since you are already on the Coumadin....I think they will have you come to the hospital a few days before for prepping. And....yes....would think they would have you bridged with Heparin up until surgery. Lovenox at home.

PS..Your heparin should be started within hours after surgery. If not immediately. Not sure what the protochol is there? I may be going in for some "non heart" realted surgery. Never thought about the process in detail. But the same protochol will apply.

 

[geebee]

I have been bridged in the hospital before each of the 3 surgeries I have had since my first OHS.

 

[Ross]

Al you may need to voice your concerns. Mine was going to leave me go 5 days without anything which was unacceptable to me, but then I had that gastro bleeding issue too.

 

[Sierra Bob]

I've had two major surgeries since the replacement of my aortic valve with a St Jude Silzone mechanical valve in 1999. Each time I've been taken off warfarin by my cardiologist four days prior to the surgery and started Lovenox injections twice per day at home, discontinuing the injections the night before surgery. Warfarin was started the next day without Lovenox. He does not approve of a Heparin drip.

I'm to have another major, major surgery in about two weeks. (Reconstruction of my right mandible with hip bone due to osteoradionecrosis <dead jaw bone as a result of radiation for cancer>). This time my cardiologist wants me to discontinue warfarin four days prior to surgery and start Lovenox injections when my INR approaches 2.0. I home test and my INR target is 3.5. This is to save me money. Love nox is very expensive, and this will save one, maybe two days of Lovenox. I only have a prescription for two days of Lovenox, but a refill order for up to 12 times in case the sugery is delayed.

 

[ALCapshaw2]

THANKS for the interesting replies.

GINA: Were you put back on Lovenox AFTER surgery?

AFTER procedure anti-coagulation seems to be the REALLY BIG UNKNOWN in the medical community. Anybody who knows what anticoagulation is seems to 'get it' when it comes to Bridging BEFORE the procedure and stopping 12 or 24 hours before the procedure. Very Few seem to understand the need for or how to go about Bridging AFTER the procedure. SCARY !!!

'AL Capshaw'

 

[geebee]

I went off coumadin 2 days before admission. Immediately upon admission I was put on IV Heparin. I was on Heparin for about 48 hours depending on surgery. The IV Heparin was discontinued 6 hours (not sure exactly) before surgery and was started again 6 hours after. I have never been on Lovenox.

So far this regimen has worked for me through 2 OHS and a hysterectomy as well as a colonoscopy.

 

[tommy]

I've had six Lovenox bridges for procedures by four different doctors. Dental, hernia, excision, colonoscopies. The bridging is always managed by my cardio. God bless him!

We finesse the bridge using results rather than time. After I go "off" Coumadin, I wait to start Lovenox until my INR gets below 2.0. After the procedure, I start Coumadin and Lovenox that night, and continue the Lovenox until my INR reaches 2.0.

I have the convenience of checking the INR at home (at least until the recent Roche screw-up ), which makes this finesse practical.

If I were to need another OHS, I might prefer to use Heparin (requires hospitalization). It means a few extra days in the big house at the front end. I'll be there for a few days at the back end anyway.

 

[bvdr]

Al, I just had a cervical root sleeve steroid injection on Thursday. I was off coumadin for 5 days prior to it and began bridging with Lovenox when my INR went below 2.5 (that only took me 2 days to reach). I could not have Lovenox 24 hours before the injection but started both my coumadin and Lovenox 12 hours after the injection.

I was on coumadin prior to OHS and was told to stop 5 days before and was put on a heparin drip the day before surgery. I think I came out of surgery with heparin infusing but it might have been only when I first thought to look at what was running a day later.

I hope all goes well with you and that this surgery goes well and lasts for a very long time.