Heart Surgery & Coumadin

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kerri73

kerri73

Well-known member
Joined
Aug 11, 2005
Messages
179
Location
Omaha, Nebraska
So have any of you gone through heart surgery while already on coumadin? I'm curious how they'll handle that with me - for my cath they had me hold it for a couple days... for my pacemaker replacement I was admitted and put on a heparin IV 2 days prior... for heart surgery... eeks... I have the question in, just waiting for the answer from the surgeon... anyone been there before? Did they admit you a couple days prior and put you on heparin?

And does doing the maze procedure in addition to surgery lengthen the post-surgical stay any? I'm hoping to be home by Saturday... Sunday at the latest (surgery on Tuesday).

Yes I have too much time on my hands to think about these logistical things. :)

Kerri
 
They'll ask you stop 5 to 7 days before your surgery. They should put you on Lovenox up until 12 hours before or admit you early and get you started on Heparin IV.

Realistically and if all goes well, your expectency of going home is possible, but not if complications come back into the picture. For instance, if they don't know how to dose Coumadin, they'll keep you until your therapeutic again and that could take more then 5 days if they don't know what they're doing. I'd plan on 7 to 10 days so that your not disappointed.
 
Lovenox shots scare me. :) Never had them before! And if you remember when I had my cath, they had me in the hospital for 6 very long days trying to get my coumadin back in range... I got pretty grumpy, but was only told I'd be there 6 hours! Finally had to start smuggling in my own coumadin. :)

Nothing ever goes as planned with me... I just need to accept this. :)
 
Hon I feel your pain, it's the same with me. Every time I go to the hospital now, I just tell people I'll be out some day. Never ever goes as planned. Not trying to discourage you, but that's the way it's been for me.

Lovenox isn't a big deal. The needle is tiny and at least to me, doesn't hurt at all. I actually like giving myself injections of it. Probably the only sick puppy here that does. Honestly though, the needle is the same as diabetics insulin syringes and they are really tiny. Oh yeah, only twice a day. Every 12 hours.
 
HI THERE

I had a mital valve replacement 3yrs ago, yes I am on coumiden, and had the maze done as well. I feel great the coumiden is something to get use to, what I mean is you just have to be careful not to cut or trauma to your body. And carry a medical alert that you are taking coumdin. Good luck.
Frances
 
I asked 3 different Surgeons about their Protocol for Bridging anticoagulated patients for second Heart Surgeries and got 3 Different Answers.

1 - Bridging with Lovenox Before and After Surgery
(The BIG Question with this method is WHEN to re-start Bridging AFTER Surgery. SOME patients have had Bleeding issues following Surgeries - Remember Ross' episode following his Dental Extractions? - Another had a Bleeding Issue when Lovenox was started 8? hours following a procedure. Had better luck waiting 24 hours following another. I 'think' I've become a believer in waiting 24-48 hours before resuming Lovenox. Starting Coumadin that night should NOT be a problem since it is so slow acting.)

2 - Bridging with Lovenox Before but NOT After Surgery

3- NO Bridging, just go OFF Coumadin 4? days before and re-start Coumadin that night, after surgery.

Bottom Line: Talk with your Surgeon about HIS philosophy of Bridging and voice YOUR Concerns / Preference so that you and he are 'on the same page' going in.

'AL Capshaw'
 
One thing that's in your favor is that you already know the dosage that is theraputic for you. Granted it may be a little less since you would naturally be less active but at least they should have a reasonable idea - not like starting from scratch. Good luck with the surgery btw.
 
Kerri,

My last OHS was in 1994 so I am not sure how things differ. I stopped coumadin and 3 days later was admitted to the hospital and started on IV heparin. My surgery was the morning of my third day in the hospital. They stopped the heparin and gave me some plasma to avoid bleeding during surgery. The heparin was restarted after surgery and coumadin the next day. I was not released until my INR was above 2.0.

I have never been on Lovenox.

This same routine was used for my second OHS and for my hysterectomy in 1988.
 
Ross said:
Hon I feel your pain, it's the same with me. Every time I go to the hospital now, I just tell people I'll be out some day. Never ever goes as planned. Not trying to discourage you, but that's the way it's been for me.

Lovenox isn't a big deal. The needle is tiny and at least to me, doesn't hurt at all. I actually like giving myself injections of it. Probably the only sick puppy here that does. Honestly though, the needle is the same as diabetics insulin syringes and they are really tiny. Oh yeah, only twice a day. Every 12 hours.
Click to expand...

The heparin and insulin shots I got in hospital were practically painless because the needles are short and sharp; they stuck me in various places--arm, stomach, etc. Not a big deal, really.
 
I wasn't on thinners so I cant answer that. I had my pulmonary replaced, tricuspid repaired and a maze procedure. My surgery was on Monday 4/20 and I was released on Friday 4/24.
 
I would agree with what Ross said. I was told to stop my aspirin a week ahead of time. My coumadin was 4-5 days ahead of time and then was on lovenox until the day before. I personally hate lovenox. I have not had problems giving myself the shots, but I find it increases my coagulation time exponentially. One time my gums bled for a day and a half. So I was happy to be back on coumadin after the surgery.

I recently had an AVR and aortic root replaced, along with a Maze. I had some minor complications and this kept me in the hospital a total of eight days including my surgery.

I don't know if this will help. I know lots of people who don't have any problem with lovenox. It has just never worked well for me.
 
I will be the first person to say that Lovenox will cause more bleeding then Coumadin. Yeap, I got experience first hand to that one.

I'm of the opinion now that you should bridge before surgery, but not after. You should restart the patients Coumadin as soon as there is no bleeding or bleeding is well controlled, after surgery.
 
I'm seeing a disturbing trend here on VR.com

Someone will post a question, read a few early responses, and then GO AWAY, NEVER seeing the (often many) continued responses and detailed discussion.

Kerri's Member Profile shows her last activity was 2 days ago and there have been 8 more responses that she has yet to view. I hope that she comes back to view the rest.

Other recent examples include Hot Rod Harry and Megan.

I hate to think that we are "wasting our time" in replying to such posts, but it makes me wonder.

'AL Capshaw'
 
lol sorry Al, I did come back to read... was out of town since last Saturday, so that's why I wasn't around to read all the posts til now! I'm glad there were so many responses to my question.. definitely gives me an idea of what to expect. Still waiting to hear what the surgeon's plan of action is on the coumadin thing, but I wouldn't be surprised if they admit me 2-3 days prior to put me on heparin til surgery. We'll see! (something about the idea of completely stopping coumadin makes me a little nervous)

Thanks again to all for your input!
Kerri
 
PS - Ross, if you read this (which I'm sure you will) :) I did subscribe to one of my posts, just so I didn't forget about checking in... and never got any e-mails when it was responded to. :( Can't remember if it was this one or my other one with my surgery date, but thought I'd share/ask. :)

Thanks!!
Kerri
 
kerri73 said:
PS - Ross, if you read this (which I'm sure you will) :) I did subscribe to one of my posts, just so I didn't forget about checking in... and never got any e-mails when it was responded to. :( Can't remember if it was this one or my other one with my surgery date, but thought I'd share/ask. :)

Thanks!!
Kerri
Click to expand...

Hon the email server is messed up. I'm not even getting notices when new members register. I've asked for this to be looked into, but hence, it has not been, so I don't know when nor how long it will continue. All I can say is to manually check when you can.
 
I have been on Coumadin for the last 20 years since having my Aortic valve replaced, however when I had surgery four years ago for a cochlear implant, I went off Coumadin five days prior to surgery, and once my INR went down to 2.0, started the heparin injections, then the night before surgery, was put on IV for them to managed.
Apparently my sister who is a nurse, say that patients are on heparin all the way through heart surgery. All the best for your surgery, I will be thinking of you. Take care. Sending lots of positive vibes your way.
 
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