To Bridge Or Not To Bridge?

[Cooker]

It's times like this that I second guess my valve choice but then when I hear of someone getting a re-op because their tissue valve is failing I'm glad I tick. I had a colonoscopy in 2012 came off warfarin and did not bridge, heart cath 2012 came off and bridged at the instruction of my cardiologist. Now I'm facing a minor (hopefully) surgical procedure and my surgeon would like me to come off warfarin but may consent to do it with me anti-coagulated.

How much does bridging protect those of us with mechanical valves anyway? Not sure I see the need for just coming off three days. Also being that I have an aortic prosthesis I understand that the likelihood of thrombotic events is much lower than with Mitral valve. I would rather deal with a bleed that an a stroke.

I would appreciate any input from out more learned and experienced members.

 

[Freddie]

Wish I could help you out Sir Cooker, but I don't have an answer just a question:
What if you were to have a bleed on the brain?
Rather be safe than sorry, yes? even if it's only for 3 days.

 

[pellicle]

Cooker
The "consensus guidelines" for the Australasian Society of Thrombosis and Haemostasis" suggest:
*withhold warfarin 4-5 days before surgery targeting an INR of < 1.5 for the day of surgery (and suggest vitamin K IV if >2)
*after surgery recommence warfarin if no bleeding with the previous maintenance dosage

They state "there are some procedures which entail a low risk of bleeding and so do not require interruption to warfarin therapy" (examples included dental, peridontal, dermatological where pressure can be applied).

They mention also that issues need to be considered and one (of two) mentioned was "potential risk of thrombosis should be assessed"

It goes on to say : "heparin offers some advantages as an anticoagulant within the 24 hours preceding surgery because of its faster onset and offset of action. There is disagreement about who should and should not receive heparin principally because there is a lack of randomised controlled trial data. In some."

let me know if you want a copy of this doc and I'll send it to you (pdf) email me gmail

(and me is pellicle ;-)

 

[tom in MO]

I would ask my cardiologist since they should be the expert on your valve and current therapuetic choices. On this forum, more than one person has gotten less than accurate advice about anticoagulation from health care providers.

 

[dick0236]

.......Now I'm facing a minor (hopefully) surgical procedure and my surgeon would like me to come off warfarin but may consent to do it with me anti-coagulated.
.

If it can be done, and the doc will do it, without going off warfarin, that's what I would do. However, in todays world, many surgical patients go off anti-coagulants for a period of time with no problems. Your cardio and surgeon have the training and knowledge to deal with surgeries in anti-coagulant patients and I would trust their collective opinion. I can't help with any "bridging" questions since I have never had to bridge for any reason.

 

[chaconne]

Even with proper procedure - Warfarin bridged with Heparin, events can happen. A week after my AVR surgery, I had an amaurosis fugax (blood clot to the eye), which caused partial blindness in my right eye for a few hours. My INR was 2.2 at the time it happened. However, I've heard the risk of this after surgery is the greatest.