Five days off Coumadin for Cortizone shot

[ALCapshaw2]

I'll stop posting it. no problem. meanwhile, I still have the same cardio. I disagreed with him also, and that's when he gave me the I've been doing this 30 years speech, and are you a doctor?. no problem with not bringing it up again. I actually disagree with my cardio and agree with what I've read on this site. it makes more sense.

That's the problem...

He is still going by the Same Book he used 30 years ago!
Tell him there is a New Edition (probably Several, since he learned the subject)

Maybe he's like the teacher in a show I saw long long ago who claimed 30 years experience. Another said it was more like 1 year of experience repeated 30 times over.

 

[Lisa in Katy]

This is interesting because I didn't know that you had to go off Warfarin for a spinal injection. That will be good to know if I ever need one.

My brother has a mechanical aortic valve and was off Warfarin for quite a while. He didn't have a stroke immediately or even with a few weeks or months. However, he did have a stroke. He was lucky in that he was able to recover from it. However, he was also stupid! Going off Warfarin doesn't guarantee that you'll have a stroke, but it greatly increases your odds. Why risk it unless you absolutely have to.

Witzkeyman, doctors that have been doing this the longest are often the scariest.

 

[Guest]

He must have learned something, because he probably doesn't prescribe 60 mg starting doses.

 

[TomS]

Thanks Everyone!

Thanks Everyone!

Thank you to Ross, Al, and everyone for your replies. Great information! I've had a chance to use some of it, so far though fortunately not all of it.
My first advice is to not spend four hours on your hands and knees cutting grout out between ceramic floor tiles. If open heart surgery hurt like my back did for three weeks, a don't know if I would have have done it!
The cortizone shot was going to go directly into my spine. I haven't had it done because the pain is subsiding and this INR issue makes it a bigger decision. The good news is that my cardiologist would have wanted to bridge me if I went through with it (levonox (sp?).

As an interesting aside to some comments, I was put on 60 mg of Prednisone for the back, and my INR went up to 4.6. A was taken off of coumadin (5mg/day) for two consecutive days, took half the next, a full one the next, had my INR rechecked and it was at 2.3. Since I've got two more weeks of weaning myself off of the steroids I'd be interested in understanding more about why you can or cannot skip daily doses. I'm sure more coumadin adjustments will need to be made. It seemed to be perfect for me. They now have me going on a Full/ Half/Full/Half schedule with rechecks weekly until it's out of my system.

Thanks again,
Tom

 

[Bina]

Tom, for an INR of 4.6 you would have been fine with one or two days of half doses.
I can't believe someone told you to hold for 2 days, that is crazy!

 

[Ross]

Tom, for an INR of 4.6 you would have been fine with one or two days of half doses.
I can't believe someone told you to hold for 2 days, that is crazy!

Ah but dear Bina, prednisone is in the picture and it makes the INR rise. I'm not sure I'd of said hold 2 doses, perhaps 1 then on the next a half dose. I guarantee if Prednisone wasn't in the picture and they told you to hold 2 doses, you'd of been in danger.

 

[Bina]

Ross, is 60mg of Prednisone considered a large dose? I'm not familiar with adult dosing of it.

 

[Ross]

Ross, is 60mg of Prednisone considered a large dose? I'm not familiar with adult dosing of it.

Yes it is. I was on 60mg a day for 5 years. I blew up like the Michellin man, had terrible mood swings and it destroyed my left femoral head making me have a left total hip replacement. It's nasty stuff over a long period of time. 20mg is the starting dose.

 

[Bina]

Ross, When my daughter was 3, she was on it occasionally for bad asthma attacks, but of course it was a tiny dose and she also swelled up. It's strong stuff.
Tom, I hope that you are able to test often and control your INR without it swinging too much.

 

[TomS]

Thanks

Thanks

As soon as I told the APRN testing my INR that I was on Prednisone, she said "well you're definitely going to be high". She was right. Ross, sorry to hear about your being on it for so long, it's nasty stuff, but seems to work to fix the nerve/swelling issue that had me only able to lie on the floor.

I'm not sure that I fully understand the bridging course. From what I was told, if I went in that direction they would do something like the following. So if there is another take-away from my post, this could be it:
1. Cardiologist takes you off of coumadin and you receive Lovenox (sp?) shots daily on an outpatient basis for several days.
2. INR goes down to 1.2 and I would have then gotten the cortizone shot in my spine.
3. Spinal Doc said that he would want to do a CT scan about 48 hours later to make sure that it's "dry" before restarting Coumadin. I'm guessing that I would continue to get daily Lovenox injections during this time until I could again begin taking Coumadin.

Sound right?

Thanks,
Tom

 

[Lisa in Katy]

Tom - Shortly after my surgery I was put on Prednisone for Pericarditis. I can't tell you what my INR was, because they only reported Protime in those days, and I don't remember what it was because I didn't really know what was going on. However, it was high enough that my doctor called me at 6:00 a.m. on a Saturday to ask me if I was bleeding or bruising anywhere on my body. They eventually tapered me down to 5 mg a day, where I stayed for about 9 months, which didn't really seem to affect my coagulation, although it's difficult to tell since I wasn't stable yet at that point. I know that I only had one other spike after the initial one, and that was when they put me in the ER for Prednisone via IV. That one was planned for though, so they had already halved my dose the day I was given the IV and continued to monitor me carefully for the next week.

 

[Ross]

As soon as I told the APRN testing my INR that I was on Prednisone, she said "well you're definitely going to be high". She was right. Ross, sorry to hear about your being on it for so long, it's nasty stuff, but seems to work to fix the nerve/swelling issue that had me only able to lie on the floor.

I'm not sure that I fully understand the bridging course. From what I was told, if I went in that direction they would do something like the following. So if there is another take-away from my post, this could be it:
1. Cardiologist takes you off of coumadin and you receive Lovenox (sp?) shots daily on an outpatient basis for several days.
2. INR goes down to 1.2 and I would have then gotten the cortizone shot in my spine.
3. Spinal Doc said that he would want to do a CT scan about 48 hours later to make sure that it's "dry" before restarting Coumadin. I'm guessing that I would continue to get daily Lovenox injections during this time until I could again begin taking Coumadin.

Sound right?

Thanks,
Tom

The 2008 recommendations are, stop the Coumadin 5 days before procedure.
When your INR falls to 2.0, begin bridge therapy until 24 hours before the procedure.
Now this part is where your Cardio is going to have to make the call since they want to do a catscan 2 days later, but your supposed to start the Coumadin and continue bridging 24 hours after the procedure and continue with bridge until 2.0 or therapeutic again, then stop bridge. My personal opinion, which is by no means professional, waiting 2 full days is unacceptable, but do what they instruct. I'd rather risk it, since it's small of having a stroke vs dying from a spinal bleed.

 

[bvdr]

I've been through the spinal injections a few times, including nerve roots and then a cervical spinal fusion. Each time I came off coumadin 5 days before and then bridged with lovenox once my INR dropped below 2.5. I had to have my last lovenox at least 24 hours prior to scheduled spinal procedures. I was able to start my warfarin the day the injections as well as resume the Lovenox for bridging. It was several days though after the spinal surgery before I could start anticoagulation again. With these procedures the risk is greater to have a spinal bleed (just as bad as a stroke) than to have a stroke from a clot. I have to go through it again soon for a spinal for knee surgery on the 16th.