Having surgery need lovenox help

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COLLEEN S

COLLEEN S

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Joined
May 5, 2008
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873
Location
Maryland, USA
Hi all,
I am having a cochlear implant put in on Thursday, my Lovenox shots start on 9-2-11 (yes tomorrow) and I just read the directions. One direction says 90mg subcu 2 times daily, that is the one from my doc. The one off this site says, 1mg subcu 2 times a day...I suppose I have to call the doctors office tomorrow to make sure? I hate the idea of this bridging and giving myself shots, but what can one do?
 
I think dose is based on weight.
You probably should check with your doctors.
Hope your surgery and the whole process goes smoothly for you.
 
Lovenox is available in many strengths - your doctor probably ordered it based on your weight. It's my understanding that you inject the complete syringe.

However, I'm a bit confused.

Your surgery is not until Thursday of NEXT WEEK. Right?

Your INR on Wednesday, and probably yesterday, was probably within range. I'm concerned that your anticoagulation may be elevated because of this early use of Lovenox.

Did your doctor tell you to completely stop taking warfarin? Is that the reason you're being bridged?

I'm not sure that completely stopping warfarin is a particularly good idea -- it'll make it more difficult to get your INR back into range after the surgery.

I'm not sure that cochlear implant surgery involves significant bleeding.

If I was having similar surgery in a week, I'd check with my cardio or other professional who understands anticoagulation and confirm that quitting a week early, and bridging for a week, makes much sense.
 
COLLEEN S said:
Hi all,
I am having a cochlear implant put in on Thursday, my Lovenox shots start on 9-2-11 (yes tomorrow) and I just read the directions. One direction says 90mg subcu 2 times daily, that is the one from my doc. The one off this site says, 1mg subcu 2 times a day...I suppose I have to call the doctors office tomorrow to make sure? I hate the idea of this bridging and giving myself shots, but what can one do?
Click to expand...

Hey girl, the latter instruction of 1 mg subcu 2 times per day should read: 1 mg PER kg (2.2 pounds) of body weight.
It would be rude of me to ask your body weight, but you can do the math.

The Lovenox shots would be started as soon as your INR drops below 2.0 and into the danger zone.
Did the docs want you to stop the Coumadin already ?
 
Hi Colleen, the lovenox is based on body weight. I had surgery on Wednesday and I restarted my Lovenox this afternoon. I stopped my coumadin 5 days before surgery and it only took 2 days before my INR was below 2.5 and started my Lovenox every 12 hours. My surgery was Wednesday so my last Lovenox was Tuesday morning. On Wednesday I was put on on heparin at the hospital and had my last heparin injection before I was discharged last night. I expect it will take me about 6 days to be safely back in range. Generally, I stay on the Lovenox for at least a couple of injections after I'm back in range. I had laprascopic nissen fundoplication done. It is the surgery that is done for severe reflux and hiatal hernia repair. It involves both the chest and abdominal cavities and was done through 5 small incisions on the abdomen. I don't know how much bleeding is involved with your surgery but I wish you the very best result. My surgery went well but I have to say that overall, I don't think that any of my caregivers were at all clear on what to do about the anticoagulation process. How long are you going to be in the hospital? I'm still on pain meds and am definitely foggy. I've not been on the board much lately so I don't know if you know what caused your hearing loss that led you to this point. I have some catching up to do!
 
Yes, they want me to stop coumadin altogether. Last dose was 9/2. Today is 9/4. Surg is 9/7. Started lovenox 90mg am and pm today. I guess I should have taken my INR to make sure it was below 2? before I started the lovenox? In what case would a surgeon cancel surgery in regards to INR? I talked to my cardio at my cardiac clearance appointment and asked her about the lovenox at 10:45.?????????
 
Colleen:

I don't have a cardio - or any MD right now, for that matter, but presumably your surgeon SHOULD know about anticoagulation. (Although I'm not sure if the advice to completely discontinue warfarin, and to bridge all week is anywhere near medically accepted practice.) I'm not sure if cochlear implant is a 'bloody' procedure, although I'm sure it's so precise a procedure in a small area that any extra bleeding can obscure the surgical area. In retrospect, perhaps an INR as close to 1 as possible -- and reduced bleeding at the surgical site - makes absolute sense. I'm just not sure that you really need to bridge YET -- with your valve and the length of time since your heart surgery, your risk is really rather low for a short period. Still, I guess, it doesn't hurt to be a bit EXTRA careful and bridge whether it's medically essential or not.
 
Colleen, when I had my pacemaker replaced with the defib, we only had about 3 days (surgery was semi-emergent due to v-tach on the highway a few days before Xmas, and surgery was done on Xmas eve) so the surgeon wanted me below 2. Friday of the v-tach I was at 3.4, held Friday night, Saturday, and Sunday. By Monday morning I was at 1.9.

When I had my second valve job, I stopped the coumadin 7 days prior, began bridging with lovenox when I dropped below a 2, so bridged for about 5 days. 1mg per kg body weight, so at 134 lbs I took 60 mg every 12 hours. My last shot of lovenox was 16 hours prior to surgery.
Does that help?
 
Colleen, if your surgery is scheduled for 9/7 then what is generally done is that you skip the lovenox the night before. That would make the injection you get on 9/6 AM would be your last one until after surgery. Lovenox is very short acting compared to coumadin. It is an off label use when lovenox is used for bridging for valve patients but it is used that way a lot.
 
Well friends, the surgery was Wed. 9/7 (yes, i posted the wrong date in previous posts.) Had the cochlear implant. I was not expecting it to be this invasive and wow, was I off! It is really a major surgery and should be addressed like major surgery. I was told they "slip the transmitter under your skin thru a small incision", and the "electrode is placed into the cochlea." Well, more like "slashed from top of ear to bottom, large hole made in skull to accomodate transmitter , smaller hole made for electrode, lots of bleeding and pain and headaches, (and in my case back and muscle aches of all kinds due to fibromyalgia). Holy crap. But I am here and improving everyday. Next up is post op appt on Tuesday, then 2 day programming when they turn the implant on. Nothing ventured, nothing gained so they say
 
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