Yet Another Colonoscopy Question

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Homeskillet

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I am sure y’all weary w. answering this question, but today I met w. a gastroenterologist who is in the process of scheduling me for a colonoscopy & endoscopy.

They are suggesting that I stop my warfarin 5 days before the procedure...with no bridging
!

My cardiologist is saying the same thing, but from what I understand, this is a major no-no w. mechanical valve - esp. in the mitral position.

I would almost rather not even have the procedure than I would stop my warfarin for 5 days straight! Would appreciate your input & perhaps links on this issue.

Thank you much in advance.
 

tom in MO

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I was told by my colorectal surgeon that there is no need to go off warfarin if you are just having the colonoscopy w/o having them remove polyps or take biopsies. That may be a route for you. The thing is though, if they find something, you have to go back for another colonoscopy w/o warfarin for them to do the biopsy or polyp removal.

I have a mechanical valve in the arterial position and stopped warfarin for 5 days w/o any problem for a TURP. I did have a small problem of extra bleeding when warafarin was re-initiated and my INR moved up.

Why do you think your cardiologist and GE doctors are incorrect?
 

Homeskillet

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Thank you men. Tom, my concern is that there is greater risk of stroke with the mitral valve. And, several others I have spoken with say “no way” they would stop Coumadin for 5 days without bridging. My Coumadin clinic lady said the same thing. She said she would prescribe me the lovenox if Inwantwd her to. I will probably bridge regardless of what they say.

Thanks Pellicle - as usual, excellent observations.
 

jwinter

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Two colonoscopys in the last two years. Off warfarin the 5 days before and bridged with both. Up to you I guess.
 

Homeskillet

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Well, just as I suspected, my cardio. told me today that I would be fine to go off of all anticoagulation for 5 days prior to procedure. He actually said that Bridging poses more potential risks than just stopping warfarin for 5 days. The gastroenterologists seem adamant that I not even bridge.

Perhaps I am stubborn, ignorant - or both, but I am not comfortable completely stopping anticoagulants with a mechanical mitral valve. My Coumadin clinic lady said she has known 2 people who had strokes while well in range - and they were both mitral Valvers. She agrees that this is quite risky.

Have another call into my other cardio. to see what she says (I actually have 2 cardio.’s). If they will not accommodate what I feel comfortable with then I will find another gastro. - or not have the procedure.
 

tom in MO

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Homeskillet;n885111 said:
Well, just as I suspected, my cardio. told me today that I would be fine to go off of all anticoagulation for 5 days prior to procedure. He actually said that Bridging poses more potential risks than just stopping warfarin for 5 days. The gastroenterologists seem adamant that I not even bridge.

Perhaps I am stubborn, ignorant - or both, but I am not comfortable completely stopping anticoagulants with a mechanical mitral valve. My Coumadin clinic lady said she has known 2 people who had strokes while well in range - and they were both mitral Valvers. She agrees that this is quite risky.

Have another call into my other cardio. to see what she says (I actually have 2 cardio.’s). If they will not accommodate what I feel comfortable with then I will find another gastro. - or not have the procedure.
Why believe the "coumadin clinic lady's" anecdotal advice when you have two doctors from different disciplines agree? My MIL was on warfarin and bridged to have an AVR. She had a stroke. It was mild and she recovered. She believed it was better than death from the bad aortic valve. Even if you are on coumadin, it just lowers the risk of stroke it does not eliminate it.

Even if the second cardio will bridge you, the gastroenterologist said he won't do the colonoscopy. Is this because you are having more than just imaging? My colorectal surgeon will give you the colonoscopy while on warfarin, but he won't remove polyps or take samples. If he sees its needed you have to come back for that and be off warfarin. Maybe your doctor will go that route.
 

pellicle

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tom in MO;n885119 said:
Why believe the "coumadin clinic lady's" anecdotal advice when you have two doctors from different disciplines agree?...
come one ... what would those bozo's know ... the clinic lady is probably a PhD graduate who did research into the efficacy of bridging perioperatively and just doesn't call herself "Doctor" because she's afraid of losing her job because she'd be more senior than the morons who employ her ... (who normally employ duller people than themselves so as not to risk being shown up to be dullards)

;-)
 

Keithl

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I have been MIA for a while as things have been great. I am at 10 months and life is like i never had OHS. Well I had to do my colonoscopy. Talked to Cardio, she wanted lovenox bridging before and after. GI took our 2 decent sized polups, one was flat at 15mm thus tough to get out. All was fine for 2 days as I started back bridging and warafrin. 2 days later blood. GI tells me go to ER. I wound up spending 2.5 days in hospital. Cardio insisted I get on heparin, even though GI and admitting DR were like "skip everything for 3 days". They went back in 2 days later (no fun not eating for 52 hours) and put more clips on and cauterized it more. Resume bridging and warafrin and bamm, 7 days later dark stool. Not as bad as first time, but almost on schedule to where GI said I may bleed again-14 days.

I have an On-X in aortic position and seems the risk of clot is very low. I am leaning toward dumping the shots since my INR is now 1.7 (not the 2-3 the cardio and I like it to be) and seeing if this heals on its own. Seems there is higher risk from GI bleed than form a clot. And sicne they got 2 decent polups this looks liek an annual thing for me. What is everyone else doing with bridging?
 
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Keithl

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One other issue I have is getting my INR back after being off takes a while, 7 days to get me to INR 1.7 so not sure I want to go 3 before then 8 after to get back in range.
 

DachsieMom

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This is an interesting discussion. I am turning 47 and think about the colonoscopy issue. My mother has polyps removed frequently and had part of her colon removed after they found a flat polyp (she spent a week in the hospital). my cardio said when I turn 50, I should stop warfarin for 5 days to get colonoscopy. My primary care doctor recommended that I stay in the hospital for a few days instead and bridge. No idea whom to believe and am scared to death of stopping warfarin. I am thinking of trying the alternative tests, like cologuard or ultrasound. Mine is in the aortic position. St Jude conduit.
 

Keithl

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The more I am reading the more I like what the GI said, bridge off, do procedure then start Coumadin again and get back above 1.5 as quickly as possible, if I am not above 1.5 in 3 days start a lower dose bridge. I have and On-X so once I get to 1.5 stop the bridge and live in the ~2 range for a week or 2 to give wound time to heal then get back over 2.

I really am not liking this and if I knew I was at this risk for polups this often I might have gone tissue valve.
 
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pellicle

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really am not liking this and if I knew I was at this risk for polups this often I might have gone tissue valve.
If you read the linked article in my blog post I believe you'll see that there is less to be concerned about with discontinuing warfarin and more with GI bleeds. Please note the veracity of that article.

People die from GI bleeds, please take this seriously and report to a doctor if you see more evidence of a bleed.
 

Rapidman

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If you have no family history of colon cancer and at low risk cologaurd could be an alternative option to colonoscopy.
 

Buckeye

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I have had colon cancer and have a genetic condition called lynch syndrome. Because of this I have to have a yearly colonoscopy. I was told by my cardiologist that I would not bridge with lovenox and would simply go off of warfarin. He said the risks of bridging are greater than just simply going off warfarin for 5 days. I had my colonoscopy right before my aortic valve replacement with an on x valve. My cardiologist new about my history and still advised me to go with the on x valve instead of a tissue because of my age of 51. I will be due in January of 2021 for my next yearly colonoscopy. I am not very keen on getting off warfarin, but I have to trust the experts, and I have had polyps every time but twice. since I will be doing this so often I wonder if it increases my chances of a clot?
 

Keithl

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Yeah my mom had colon cancer and I had 2 polyps removed 4 years ago and 2 larger ones removed 2 weeks ago, so colorguard is not an option for me. Since I am 58 I still think mechanical On-X choice was right for me. I think this colonoscopy episode taught me a few things. Next time I will bridge off until colonoscopy then if the remove polyps I will just start Coumadin for next 2 days or so and ask cardio about minimum dose Lovenox to hell bridge back, since it takes me 8 days to get back over 2. Since I have an On-X as sooo as it get to 1.5 I will drop Lovenox add my 81mg aspirin until I get back to 2+. I agree with what I have read that the GI bleed risk seems higher than the clot risk.
 
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Protimenow

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I've had some small procedures where the surgeon wanted my INR around 1.5 - 1.7. I chose not to bridge, because, returning to my usual dose brought my INR back in range in 2 or 3 days. It takes longer than that for a clot to form.
 

Keithl

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My usual dose is 6.75 (3 + 1/2 of a 7.5) keeps me around 2.5. Last 3mdays I spiked each dose with extra .5 and will pull,back now hoping to land in zone tomorrow. Today is day 7 dose this morning last night I was 1.7 so with daily 81mg aspirin I am in theory within range for the On-X,but I prefer to be around 2.5.

I am trying to understand the bridging dose cardio gave me100mg/ml. I thought I read that 30-40mg is bridging dose recommended.either way yesterday AM was my last Lovenox, I don’t like the way I feel on it as Coumadin ramps up and have been feeling dizzy, light headed and short of breath last 2 days.
 
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