Hernia Repair Surgery While On Warfarin

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I wonder, how many Doctors read these things? If they read them, then why are they not up to speed on things?
 
Gotta love that Mayo Clinic....They seem to be on the cutting edge of most medical procedures and practices. I received the best treatment there that I have even received from any medical concern.
Blanche
 
When having surgery, you always want the cutting edge to be sharp.
 
allodwick said:
When having surgery, you always want the cutting edge to be sharp.
Click to expand...
Cute :) May the knife be sharp and the pain be dull!

I am satisfied to have an expert in the specific procedure do the cutting/snooping/digging, and even stipulate some terms such as a bridge. Then my cardio manages the bridge. I know that others feel very strongly against this thinking and I respect their (your) views.

My issue is that the Lovenox (bridge) dosage based on body weight gets me a dose that seems way too large for me. My inguinal hernia site oozed for days "down there".

I wonder how much research has gone into determining the bridge dose. If we all have varying sensitivities to Coumadin and vitamin K sources, it would seem logical to have varying sensitivities to Lovenox and Heparin. Body weight seems to simplistic.
 
tommy said:
Cute :)
My issue is that the Lovenox (bridge) dosage based on body weight gets me a dose that seems way too large for me. My inguinal hernia site oozed for days "down there".
Click to expand...

Tom - did they make an attempt to adjust your Lovenox dose knowing that this happens to you, or are they afraid they risk giving you too little?
 
It all makes sense to me now. I have had post surgical bleeds with Lovenox involved. From heart surgery to wisdom teeth. Would one be better off on Heparin until the levels come up? It takes so darn long for my levels to rise after being off Coumadin. Think they would drop kick me out the door with a syringe in hand:p
 
The latest thinking about bridge therapy is that maybe the post-op doses have been too large ot started too soon. The studies have mostly used 1 mg per kg for both pre and post op doses. Some are now trying 0.5 mg per kg for the post op dose. Some are saying go ahead and start warfarin on the night of the procedure because it is slow to build up but hold the Lovenox until the next day.

You are correct in your observations that there may be too much bleeding the way that it was being done.
 
Karlynn, the cardio hasn't wanted to second guess the Lovenox dose.

It's been a few years since my last bridge, so Al's comments are encouraging about the next one (if ever?).
 
I found this doing a search. Glad to see it! And I'm very grateful we can search archived posts for later use.

I've developed one of these hernias (d*@n!) and my PCP gave the name of 2 specialists. My PCP said they'd probably need to put me in the hospital on heparin drip, etc., etc., he would not advise taking me off warfarin because of the mechanical valve.

I'll call the specialist officed in the same building and see him, take him a copy of this and have him check it out. I'm willing to stay on warfarin and have him have to stop the bleeding vs. going off warfarin and having a stroke.
 
***Note to self***

Remember to do away with searching of archived posts, just to mess with Marsha's head. :D
 
hi al,
that is a very interesting post. i must forward it to my dad .
if you remember about 2-3 years ago, they almost killed him when they did hernia repair surgery and bridged his coumadin and he almost bled to death, developed a hematoma the size of a football and looked like skin and bones for a year thereafter. his recovery was so difficult.
if only his surgeon (a real dummy who knew nothing about coumadin at all) had asked, read, learned.

i will be sure to pass that one on!
be well,
sylvia
 
sylviayasgur said:
hi al,
that is a very interesting post. i must forward it to my dad .
if you remember about 2-3 years ago, they almost killed him when they did hernia repair surgery and bridged his coumadin and he almost bled to death, developed a hematoma the size of a football and looked like skin and bones for a year thereafter. his recovery was so difficult.
if only his surgeon (a real dummy who knew nothing about coumadin at all) had asked, read, learned.

i will be sure to pass that one on!
be well,
sylvia
Click to expand...

Do you mean they bridged his Coumadin with Lovenox without withdrawing the Coumadin?

Or incorrect bridging caused the bleed?
 
hi lance,
would you believe visiting nurse service came to give him lovenox (before resuming coumadin, following surgery) and they did not check his PT... man almost bled to death.
he was rushed to the ER with a bp of 60/45!!!!! the doc told my mom to call all kids, he didn't know if he'd last!!!

can you imagine?
 
Part of my warfarin-management seminar is bridging. It is still a learning process. One of the things that we are learning is that we have been too aggressive with the heparin and there have been too many bleeds. We are delaying the use of, or cutting the dose heparin post. op.
 
Not really. When it is given for valvers it should be 1 mg per Kg (or 2.2 pounds) every 12 hours.
 
I have an appt at 4:15 p.m. May 1 with a surgeon. I asked the woman making the appt if he's dealt with patients who have mechanical heart valves. Supposedly he has and she said, "It's not a problem."

Al or anyone: How do I get a copy of the article from the American Journal of Surgery?
 
Priny my page and then ask a librarian to get the article. Marsha, they may even be able to get it at the newspaper where you work. You probably can print it directly from the journal for a fee.
 
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