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)

;-)
 

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