A Situation that needs your opinion.

[RandyL]

Please bare with me on this one but I would like some opinions from you all. As some of you might know I had some tough times with my AVR and am still facing more tough times.
I recently got my records from the hospital and was reviewing my lab reports looking for somw answers. This is what I found:
Jan 16 600pm(night before Paricardial window) INR was 2.65
Jan 19 1230pm(day after pericardial window) INR was 3.68

How can this be? It would seem like I was operated on fully therapeutic. Of course if you look at my signature you will know why this is importanrt to me.Would my bleed be caused by the therapeutic INR levels during surgery?
I just want to find out why it happened to me and my Surgeon said he does not know how it happened.

So I would like to see what you guys think.
Thanks

 

[geebee]

Absolutely an INR that was climbing from a 2.65 (since it was 3.68 the day after) is probably either the cause or a huge factor in your bleeding issue. How can the surgeon say he had no idea of what could have caused the bleeding with records like this? Did he not check the INR before operating? If not, who was supposedly responsible for checking it?
I think you have discovered a big issue here.

 

[Karlynn]

I think you have good reason for being concerned. If there are no other recorded INR's it would seem your only assumption was that they operated on you while theraputic. I think you deserve answers. Maybe someone with more experience than I can give you the best place to start.

If it were me and I had gone through what you did, I would be absolutely livid. I'm encouraging you to take some deep breaths and proceed methodically, knowing that stress isn't going to do you any good.

 

[bvdr]

If that is correct information I think it could be the cause of the bleeding. Do your records show that FFP (fresh frozen plasma) or any other blood products were used during surgery to possibly counter the high INR? If I were you I think I'd want someone who understands the issues take a good look at your records.

 

[Ross]

Ah oh, someone is in deep doo doo on this one. Hassan Chop

 

[LUVMyBirman]

Sounds like you have something to broach with that facility Randy

My INR was 12. Yes, no mistake in the number. It was an idle case of INR mismanagement. I was 4.0 with a fresh surgical site and was informed not to reduce my dose. At that point...I was naive as far as managing an INR.
Outcome was massive hemmoraging in most of my vital organs. Including the brain. It's a true miracle I am still around.

They gave me FFP (Fresh Frozen Plasma) prior to my window. They drained 2 liters of fluid from around my heart. No bleeding afterwards as I assume did plenty of that beforehand. The FFP and a full transfusion took care of that.
After all of that, the surgeon informed my family I would most likley not pull through. But they would " do their best".

We did not have a legal leg to stand on. If I would have died...then my family could have gone after them. Sad. What I really wanted is for the two doctors involved to lose their licenses. God help their patients!

Would have to say that major set back hindered my recovery. Both mentally and physcially. Sounds like you are in the same boat. Take faith...it will get better.

Take care.

 

[Guest]

There is a part of the hospital record called the medication administration record. It would show whether or not you were given warfarin the night before the procedure. The INR pattern would indicate that you probably were, although the INR could go up because warfarin acts so slowly. However, even the INR prior to surgery indicates that you should have had some type of reversal.

 

[RandyL]

Al , A home nurse gave me a Lovenox shot on the afternoon of the 16th and I had already taken my coumadin that morning. I was admitted to the hospital late afternoon on the 16th and had my surgery first thing on the morning of the 17th.

 

[ALCapshaw2]

Al , A home nurse gave me a Lovenox shot on the afternoon of the 16th and I had already taken my coumadin that morning. I was admitted to the hospital late afternoon on the 16th and had my surgery first thing on the morning of the 17th.

WHO was managing your Lovenox (and Coumadin) for this surgery?

When I had a Colonoscopy and Upper Endoscopy, I was told to STOP the Lovenox injections 24 hours BEFORE the procedure. (Hmmm.... now that I think about it, no one checked my INR before the procedure...)

'AL Capshaw'

 

[Guest]

The Lovenox was to prevent clotting after you were off the warfarin. You should not have had a Lovenox shot within 12 hours of the surgery. It looks like they either forgot to tell you to stop warfarin or that you misunderstood the directions. It appears that they thought that you were stopping warfarin or they would not have made arrangements for the nurse to give you the shot. Still, they tested the INR, knew it was therapeutic and went ahead with the surgery. The INR test the day of the surgery was to check that you had stopped warfarin. Lovenox does not affect the INR.

 

[RandyL]

The Lovenox was to prevent clotting after you were off the warfarin. You should not have had a Lovenox shot within 12 hours of the surgery. It looks like they either forgot to tell you to stop warfarin or that you misunderstood the directions. It appears that they thought that you were stopping warfarin or they would not have made arrangements for the nurse to give you the shot. Still, they tested the INR, knew it was therapeutic and went ahead with the surgery. The INR test the day of the surgery was to check that you had stopped warfarin. Lovenox does not affect the INR.

Al,
Let me explain this a little better for you. I was home from my AVR and was getting Lovenox shots from a nurse that was coming to my house daily to test my INR and give me a check-up a long with administering my Lovenox shots. I was taking my coumadin daily and the Lovenox shots were because I wasn't therapeutic yet. They let me leave the hospital after my AVR even tho I was not therapeutic. On the 5th day home my nurse came as usual to give me my Lovenox shot and check my INR along with checking me out. She heard an irregular heart beat and said I was in A-Fib. She called my Cardio and he then directed me to come to his office immediately. After an Echo was done he made me go directly to the ER for Pericardial Effusion. I was checked into the hospital that night and was in the operating room the next morning for a Pericardial Window After my window was performed the next day I had a major internal bleed which put me back into the OR for an emergency Sternectomy. My INR was 2.65 before the pericardial window on the 16th and it was 3.68 after the emergency sternechtomy on the 19th.
I am trying to find out why I had the massive bleed since the Surgeon told he had no idea why it happened.

 

[ALCapshaw2]

"What we have here is a Failure to Communicate" (from the movie "Cool Hand Luke")

It appears to me that the surgeon was clueless about your INR / Coumadin / Lovenox status.

Get copies of EVERYTHING.

You probably know what to do next.

'AL Capshaw'

 

[Karlynn]

They should have been giving you something the night before to bring your INR down if they were wanting to do the window ASAP. Someone or ones dropped the ball big time.

 

[Guest]

It is unfortunate that this happened. However, since you made such a great recovery, I don't think that you would have an easy victory in a lawsuit. The defense will do everything they can to show that you had no long-lasting ill effects. They will probably even get a copy of you holding the fish toi shoiw to the jury.

The defense will claim that it was a life threatening emergency and that they had no choice. They should have reversed your warfarin and probably would have saved the second surgery, but you are not going to look pathetic enough to win. I think you just have to be thankful that you are not in worse shape and chalk it up to experience.

This is also an example of why I am not as strongly in favor of Lovenox bridging as I once was. Major bleeds do occur. This is not to say that Randy should not have had both warfarin and Lovenox, but it is an example of a good treatment gone bad.

 

[Karlynn]

If I were Randy, I don't think my intent would necessarily be a law suit. But I would be darned sure that the "powers that be" know that a big mess-up occured that endangered my life.