Coumadin and colonoscopy/endoscopy...

[halleyg]

It's me, back again. I have been having stomach issues off and on since my surgery in August. I was fine for a couple of months, which just happened to be the time while my INR was low (I'm convinced the coumadin, when in range, is affecting my digestive system but I could be wrong). Then it started up again, which was also while I was taking amoxicillan for strep throat. I already had an ultrasound of my stomach and a few other tests by my internist, which were all negative. Of course that's when we found out I had hemangioma's in my liver and cysts on my ovaries... gee, this is fun. Anyhow, get to the point, right? Stomach issues return so I'm referred to a GI dr. who I went to yesterday. Will be getting more tests, more meds, more ct scans, more fun. It's possible I could have antibiotic-induced colitis or an ulcer. Eventually, she wants to do a colonoscopy and endoscopy, but she said I'll have to go off the coumadin for these so she's not in a hurry, which is good. I was just wondering if anyone here has had these tests while on coumadin. How hard is it to go off? All I know is something about shots in my belly. Anyhow, thanks for listening to my ranting post. It was at least therapeutic for me

 

[Nancy]

My husband had several colonoscopies. He did go off Coumadin for a couple and did not for one. The problems with going off--well, we all know what they are. The problems with staying on and having it done is that if they see a polyp or something like that, they want to take care of it while in there, and your intestines bleed quite a bit, so they cannot do that when on Coumadin. And Joe DID have a polyp (small) when on Coumadin, they just left it in there. People have done the virtual colonoscopy, but there again, if something correctable if found, it cannot be done with this type of colonoscopy, so you would have to have another one done (which is not a fun thing) w/o Coumadin anyway.

The shots in the belly they mentioned are no doubt, Lovenox shots which are used as bridging when coming off and going back on Coumadin. You do those yourself. The alternative is to go into the hospital for IV Heparin, and very few would choose that.

Joe always had to go that route because he had bad reactions to Lovenox shots.

 

[ALCapshaw2]

If all your GastroEnterologist wants to do is have a "Look See", that can be done while anti-coagulated, both the Colonoscopy and Upper Endoscopy.

IF the GI Doc wants to remove a polyp or take a Biopsy, they prefer that you NOT be anticoagulated.

I had BOTH a while back and my GI Doc refused to do it while I was anticoagulated so I did the Bridging Protocol, under the direction of my AntiCoagulation CRNP. The shots are NOT painful, but can lead to bruising (purple belly) if not done properly.

Some advise applying an Ice Cube to the target area before injection. Do NOT push the plunger before insertion (i.e. do not push out the tiny air bubble).

PINCH your skin and use a quick wrist motion (like throwing a dart) to hit your target. (I confess I wasn't comfortable with this and just 'pushed it in' but that usually resulted in bruising). Another alternative is to have someone else actually do the injection, preferably using a 'wrist throwing type motion'.

MY Bridging schedule called for stopping coumadin, starting the Lovenox 24 hours later, stopping Lovenox 24 hours before the procedure, resuming Lovenox the night of the procedure (i.e. approximately 8 hours later), and continuing Lovenox until your INR is back in range.

SOME managers have you wait until your INR drops to 2.0 before STARTING the Lovenox. Of course this requires another INR Test.

'AL Capshaw'

 

[Karlynn]

I thought this was a well-explained response.

http://yourtotalhealth.ivillage.com/anticlotting-drugs-amp-colonoscopy.html

 

[Ross]

I need Warren's files.

He is the go to colonoscopy/anticoag King.

I had mine done fully anticoagulated. That wasn't the plan, but that's the way it went. Had two polyps removed with no bleeding and no troubles beside a furious appetite.

 

[EVELYN]

Tyce and I just had colonoscopies done last year......he was FULLY ANTICOAGULATED. Our dr. just told us that if he saw anything he would have to have another procedure, but luckily he didn't .....If your dr. can do it while you're anticoagulated, it's absolutely worth it. If he doesn't want to, I'd look around for another who will.

Evelyn

 

[Bina]

Halley do you take aspirin?
Last week my cardio took me off of them (after 2 years), and I really think that my digestive system is much happier. Coumadin, taken wth dinner, has never been a problem.
I had my daughter give me a Lovenox shot once before, she was more than thrilled to stab me.

 

[Blanche]

Halley:
I echo what others have said. Al has had two colonoscopies when he was FULLY ANTICOAGULATED. No problems whatever. If your doctor is not agreeable, you need to consider getting someone else to perform this procedure.
Blanche

 

[Ross]

http://www.asge.org/WorkArea/showcontent.aspx?id=3024

Copy this and read it or print it out.

 

[warrenr]

thanks ross

thanks ross

I need Warren's files.

He is the go to colonoscopy/anticoag King.

I had mine done fully anticoagulated. That wasn't the plan, but that's the way it went. Had two polyps removed with no bleeding and no troubles beside a furious appetite.

Ross,
I think you covered it quite well.
Bottom line is regardless of your valve position and if you are going to have a colonoscpy you have to have protection.

 

[halleyg]

Thanks for the input... I don't know if this dr. will do it without me being off coumadin so I guess I could go for a second opinion. I will ask the nurse at the coumadin clinic, as well. One of the linked articles made me want to stay on the coumadin since it seems the risk is higher for something going wrong since I have a mech. MV. If I do have an ulcer it is probably from constantly worrying about coumadin, and I am a laid back person. Guess it's easy if you don't have any issues but it's been driving me nuts for three months. Thanks again everyone.

 

[Karlynn]

Halley - you're right, those of us with Mitral valves do have the higher risk of clot due to the fact that the blood flow over the valve isn't as forceful as with the aortic valve.

If it's a diagnostic colonoscopy and endoscopy, if it were me, I'd look for someone who will do it while I'm anti-coagulated. My thoughts are that if they find something that needs to be done while off of ACT, then I guess I'd just have to go in again. I personally am not comfortable with stopping ACT for possibilities, unless they can give me a pretty high percentage that they'd need to do something.

 

[catwoman]

Halley:

Our GI's office normally orders warfarin patients to go off the Rx for the procedure.
That said, the doctor has told me that mechanical valvers, particularly mitral valvers, must (1) remain on warfarin but at a lowered INR than usual, (2) go off warfarin & take Lovenox shots or (3) go off warfarin and go on a heparin drip, i.e., have the colonoscopy/endoscopy in the hospital.

 

[perkicar]

Bridging

Bridging

Where can I find a bridging recommendation that I can give to my cardiologist? I'm having a colonoscopy on Jan 4, and rather than going off my coumadin 3 days before the procedure, I'd much rather bridge. The last time I had one (2 years ago), they didn't even check my INR the day of the procedure. It took me a while to get myself back in range.

Carolyn

 

[Ross]

Where can I find a bridging recommendation that I can give to my cardiologist? I'm having a colonoscopy on Jan 4, and rather than going off my coumadin 3 days before the procedure, I'd much rather bridge. The last time I had one (2 years ago), they didn't even check my INR the day of the procedure. It took me a while to get myself back in range.

Carolyn

Now this is scary. Your Cardiologist doesn't know how to bridge? Do you know for sure that you even need anything done in there? I'll get you a link, but you can do this anticoagulated. If something is found, then maybe they'll think of taking you off , bridging and doing the scope again.

http://www.asge.org/WorkArea/showcontent.aspx?id=3024 page 776 bottom right hand side.

 

[ALCapshaw2]

Where can I find a bridging recommendation that I can give to my cardiologist? I'm having a colonoscopy on Jan 4, and rather than going off my coumadin 3 days before the procedure, I'd much rather bridge. The last time I had one (2 years ago), they didn't even check my INR the day of the procedure. It took me a while to get myself back in range.

Carolyn

Carolyn,

Whoever is managing your INR should know how to set up a Bridging Schedule. A CRNP at my A-C Clinic set up my schedule, approved by my Cardio, and agreed to by my GI Doc. NO PROBLEMS other than my reluctance to actually 'throw' the injector into the target site :-(

BTW, did you receive the E-mail I sent to you recently?
I'm looking for the Telephone Number and / or E-mail address for Dr. Lytle. If you prefer a non-public response, send an e-mail to my "user-name"@AOL.com

'AL Capshaw'

 

[perkicar]

Now this is scary. Your Cardiologist doesn't know how to bridge? Do you know for sure that you even need anything done in there? I'll get you a link, but you can do this anticoagulated. If something is found, then maybe they'll think of taking you off , bridging and doing the scope again.

http://www.asge.org/WorkArea/showcontent.aspx?id=3024 page 776 bottom right hand side.

Well, I've had two scopes and polyps removed both times, so I'm expecting the pattern to continue.....

The last time I wanted to bridge they weren't very cooperative, in fact my GI doc didn't even check an INR when I came in for the test. I did, however, get my antibiotics! Anyway--I want to have an idea of what I should be doing before I ask them about it.

And believe me, the idea of going through the prep again is not appealing to me, I'd rather get everything done in one "visit".

 

[Ross]

Well dear they did mine fully anticoagulated and still removed some growths. No problems at all for me, but it wasn't the plan before starting.