Dosing after colonoscopy

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Borstar1

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Dr wants me off warfarin for 5 days, I have a st Jude mechanical aortic valve. My question is can I begin my regular dose the afternoon of the procedure if there are no issues , polyps removed, etc. Dr didn’t give me instruction for resuming, just off 5 days before. Thank you
 

Mister_James

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Absolutely.
Regardless of whether they removed polyps or not, you should restart therapy because it will take 3 to 5 days to get you back into therapeutic range.
 

pellicle

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Dr wants me off warfarin for 5 days, I have a st Jude mechanical aortic valve. My question is can I begin my regular dose the afternoon of the procedure if there are no issues , polyps removed, etc. Dr didn’t give me instruction for resuming, just off 5 days before. Thank you
I would resume directly after procedure. You'll be INR = 1 pretty much.

Do you self test?

There is what I did and why (its detailed)

read it with the sort of attention that comes with the motiviation of "I don't want to have a stroke"

happy to take questions
 

pellicle

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Yes I self test coagucheck Xs for several years. Thank you both for replying
So do you know how fast you drop?

What is your usual dose to maintain your INR?

I'd discuss with your proctologist if your INR can be (say) 1.4 if you know how long that will take.

Hopefully my data helps.

Best Wishes
 

Borstar1

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I don’t know how fast I drop, I’ve never been off of it. I take 17.5 mg per day , range is 2-3. Thank you for the Info you posted.
 

RAS

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I don’t know how fast I drop, I’ve never been off of it. I take 17.5 mg per day
I think that's a higher daily dose than most patients. Might imply you will have a rapid drop below therapeutic range. I assume from your post you have no personal history of low or no anti-coagulation therapy since you have had your SJM valve, so it's difficult to assess that side of the risk from anything other than population studies.

Is this just a routine Colonoscopy based on age? No symptoms, personal history, family history of issues? If so, then you might want to discuss with your doctors the possibility of lowering your INR to the low end of the range or maybe a bit below it, but not all the way to normal (about 1). Also consider bridging which would limit the time without any anti-coagulation therapy.
 

Borstar1

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Yes , just routine as I’m 52. I’ve kept it in range for past few years. I will ask about heparin. Thank you
 

jlcsn2015

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I think my dose is very small compared to others, for some reason i keep my INR within range taking 2.5 mg a day for weeks, then 3 mg a day for weeks, and if i take 1 mg for 3 day it drops 0.2 per day.

I do not eat much greens but do drink green tea , olive oil, beans, etc, but it seems i react vert strongly to warfarin.
 

pellicle

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Hi

I don’t know how fast I drop, I’ve never been off of it. I take 17.5 mg per day , range is 2-3. Thank you for the Info you posted.
ok ... well it may be that you drop fast with that dose requirement. Did you pick up the point about my re-commencement in my blog post?

Best of luck with the colonsocopy.

:)
 

Woodcutter

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As I had a colonoscopy last week and literally have my anticoagulation instructions in front of me, I will share in case they are helpful . . . .

- Last day of Coumadin: 10/13/21 in the evening [note: I am quoting the instructions but I am actually on the generic at 3 mg/day]
- Start Lovenox 80 mg injections every 12 hours on 10/14/21 in the evening [note: I actually took the generic enoxaparin]
- Last dose of Lovenox 10//18/21 in the evening
Procedure was 10/19/21 in the early afternoon
- Restart your regular dose of Coumadin and Lovenox 80 mg [this was the evening of the procedure]
- Monitor INR with Home Monitor
-Stop injections when your INR is 2.5 or greater

Couple more fyi's:
- My cardiologist wanted me to bridge because I hit a few of the risk factors (mechanical valve in the mitral position, history of blood clots, history of afib/aflutter)
- My cost for 20 injections was about $150.
- Had one good bleed on one injection. Still have the 3 inch diameter bruise.
- All was uneventful/uninteresting (i.e. the best result). Been doing these every 5 years for a while due to family history.
- My understanding is that standard dosing of Lovenox is 1mg/kg.
- Can't say the shots are fun . . .. . but we've all had worse!
 

Mister_James

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You can also ask the doctor
I don’t know how fast I drop, I’ve never been off of it. I take 17.5 mg per day , range is 2-3. Thank you for the Info you posted.
Uhm are you sure?
You are +10mg above me and I thought I was a warrior at 7.5mg
 

pellicle

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You can also ask the doctor

Uhm are you sure?
You are +10mg above me and I thought I was a warrior at 7.5mg
dude ... you don't even rate an honourable mention, 10 is actually quite common.

660 mg per day.

Picture this - you go to visit your in-laws for Christmas and you forget your warfarin. You go to the ER and try to convince the doc to write a prescription.

Now if you were successful you trundle down to the local Walgreens to see if they have 7 bottles of warfarin 10 mg tablets on hand.
 

Mister_James

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I think my dose is very small compared to others, for some reason i keep my INR within range taking 2.5 mg a day for weeks, then 3 mg a day for weeks, and if i take 1 mg for 3 day it drops 0.2 per day.

I do not eat much greens but do drink green tea , olive oil, beans, etc, but it seems i react vert strongly to warfarin.
Start eating greens. They are good for you. We do need vitamin k and all the other good stuff in greens
 

leadville

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I don’t know how fast I drop, I’ve never been off of it. I take 17.5 mg per day , range is 2-3. Thank you for the Info you posted.
I agree with the others that at that daily dose you will drop quickly.
For reference at 15mg myself I have had 2 previous surgeries whilst on warfarin ,
I can be back at INR of 1 in ~ 2 days 3 at most I would suggest you will be very similar.
Good luck .....
 

pellicle

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Wait....what? 660mg/day...
Yep, there's some insane doses.
Best thing is the other point Al made about 60 years experience with the drug and we still are only sure if one effect => anticoagulation.

Myself I would not want any of the more expensive alternatives even if they were shown to be suitable.
 

pellicle

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I do not eat much greens but do drink green tea , olive oil, beans, etc, but it seems i react vert strongly to warfarin.
if "it" is green tea then yes it is reported to interact with warfarin.



But if "it" is the nutrition of greens then you aren't getting that in Green Tea

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you need to eat greens, well if you want to have a healthy metabolism and avoid any deficiency diseases. If you think eating greens is "contraindicated" for those of us on warfarin you're using old mumbo from the same dopes who brought you the health benefits of margarine (aka Nurtitionalists). These people are (in the main) not even real clinicians.

Eat greens because good for you, and any perceived concerns about its influence on your INR need to be simply accounted for in your dose. I would be interested to see your data to show that eating greens (not that I'm sure you've claimed that it does) requires a significant alteration of dose.

Best Wishes
 

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