holding warfarin for cervical surgery

[bvdr]

Well, this is a quick note for others who will face spinal surgery like this sometime in the future.

1. I stopped the warfarin 7 days before the scheduled surgery. On my own I decided to double up on my last dose in hopes of staying in range a day longer.

2. My doctor wanted daily INRs so I started them two days later (5 days before surgery) and my INR was 3.4

3. 4 days before surgery my INR was 2.2 and I began Lovenox injections every 12 hours and continued them until the evening of 2 days before surgery. 3 days before surgery my INR was l.3 and that was the last pre-op home test I did.

4. I had no warfarin or Lovenox the day before surgery and was off both until the evening of the 7th day. I was allowed to resume both Warfarin and Lovenox on the 8th day but I actually started my warfarin the evening before and the Lovenox every 12 hours on the 8th day.

5.My doctor prescribed loading doses equaling about three times what I normally take for the first two days when I resumed the warfarin. I know this is usually not done anymore but I complied.

6. I began home testing again two days after restarting warfarin and that INR was 1.0. The third day 1.5. The fourth day 1.8. The fifth day 1.9. and today is the 6th day back on warfarin and my INR is 2.6.

7. I am to have two more days of Lovenox since I have just reached my range and then I'll be back on warfarin only.

I'm on the home stretch now and so far things have gone very well. I was off everything for 6 1/2 days and that was the result of my doctors and me really weighing the risks. It was less than the neurosurgeon was comfortable with but went along with it anyway. I don't know how long I need to continue watching out for problems but I think it has to be getting less each day. Maybe Al will weigh in on this one.

 

[Ross]

Sounds right to me except for the loading dosing, but hey.

How is my BVDR now?

 

[Nancy]

I agree with Ross about the loading dose, it always overshot the mark by a LOT for Joe when it finally kicked in, and then there was a long period of time of yinging and yanging before it stabilized.

Since you are doing your own testing, it should work out better, though.

 

[bvdr]

The loading dose was not in my plan either. I'm a little concerned about yoyo-ing too but hopefully not too badly. As for me, I started on muscle relaxers yesterday for my upper back and left shoulder. My arm feels better but it has a ways to go. My foot is much better and I'm getting around the house much better too. All in all I'm on the mend. I'm not discouraged but trying to be very patient.

 

[Ross]

The loading dose was not in my plan either. I'm a little concerned about yoyo-ing too but hopefully not too badly. As for me, I started on muscle relaxers yesterday for my upper back and left shoulder. My arm feels better but it has a ways to go. My foot is much better and I'm getting around the house much better too. All in all I'm on the mend. I'm not discouraged but trying to be very patient.

Well let me know when I can start the happy dance.

 

[Guest]

The difference between this loading dose and ones when you are just starting warfarin is that this one was based on a dose that had already been shown to be correct for you.

 

[Karlynn]

I'm really happy to read that things are going very well. Wishing you the best!

 

[tommy]

Sounds good, Betty. Keep it up!

 

[bvdr]

Just a quick update. I'm doing fine. I do think I'd rather have another heart surgery than cervical surgery but of course this is fresher on my mind.
I have a follow-up visit with my orthopedic doctor on Monday and then with my my neurosurgeon on Tuesday. Both days include x-rays on various body parts but again I expect no nasty surprises. My INR is where it should be and I'm no longer on Lovenox. I'll let you know how everything goes. Thanks for everyone's support. One of these days I might even be able to drive again!

 

[bvdr]

The difference between this loading dose and ones when you are just starting warfarin is that this one was based on a dose that had already been shown to be correct for you.

Thanks Al for weighing in. You know how much I value your opinion in matters like this.

 

[bvdr]

Well, I've had my follow-up appointments with my neurosurgeon and my orthopedic surgeon. Yesterday I got the news that there is evidence that bone healing is beginning. That in itself is very good news since the area of the fracture has a bad reputation for healing problems. The disappointing news was that I will have to wear the cast boot for at least another month and then we'll do another x-ray and go from there. I'm also being scheduled for a complete bone scan to check on the tumor in my shoulder to make sure that all is still well. I can't drive yet either.

My appointment with the neurosurgeon today was much better. The x-ray showed great alignment, the neck incision is healing well and I no longer have to wear a collar. That is pretty good for being only three weeks out from surgery. My left arm is much improved with NO numbness or tingling and feels so much more normal. My shoulder is still pretty bothersome but that will take time. The neurosurgeon's PA went through what was done during surgery and gave me a copy of the Operation Report. They said I was a "perfect patient." Hard to believe but that's what they said!
They worked very hard to maximize my chances for a great surgical outcome. I am so happy to have it behind me and so thankful that I had no complications from being off anticoagulation. I see them again in 3 weeks.

So that is the news for now. Thanks again everyone for your support.

 

[Nancy]

That's a good report, Betty, thank goodness!

 

[Karlynn]

Wonderful report Betty! I'm so very happy for you that everything went well.

 

[Guest]

Betty,
We knew that you were perfect.