a small surgical procedure (and ACT management)

[pellicle]

I'm going in for a small surgery to knock some arthritis off my toe joint, so in line with my previous procedure approach I'm going to manage my own INR around the surgery. The surgeon seems very comfortable with my process and indeed has suggested that I don't really need to go off warfarin for the procedure. I am however going to reduce my INR for the surgery.

My plan is

• to take a half dose tonight
• skip the dose the evening of the surgery
• resume normally the next evening after the surgery

I'll monitor my INR and report.

 

[tom in MO]

I've had two surgeries on warfarin. One needed the INR dropped and the other did not. Why would you not follow the surgeon's advice and remain on warfarin? Why risk a clot if you do not have to?

With the surgery I needed the INR dropped for, the surgeon had my cardiologist manage the drop. With the one I didn't need the INR dropped for, I took the word of the surgeon.

 

[pellicle]

Why would you not follow the surgeon's advice and remain on warfarin?

he didn't exactly say "you should remain on warfarin" ... but as to why I may wish to restore some greater levels of coagulation immediately around sugery are because of the 100:1 ratio of benefits from that (not having bleeds) vs having any stroke issues. Particularly because I'm in the lowest risk of stroke.

However as this is not a bowel procedure (highly noted for its bleed complications) I am more concerned about healing (which btw isn't really what the Orthapedic surgeon gets involved with, that's someone elses job).

Lastly Gail in Ca had a tumor exorcised and hat bleeding complications that went on for ages and led also to an infection on the site ... I've tried to find the post but can't now, none the less that's a factor in my mind too.

 

[Eva]

Good luck and keep us posted!

 

[pellicle]

Back in ward.
Interestingly, even with the halved dose my INR just prior to the procedure was 2.7

So clearly I'd have been higher without that drop.

Will resume warfarin tomorrow.

 

[Warrick]

 

[pellicle]

I was convinced that evening (so the 16th) to take 6mg by the RN, measured my INR in the evening of the 17th and it was 2.8. So I didn't take a dose last night.
Measured again this morning (the 18th and its 2.6, so I'll resume prior dose tonight.

All this goes to show that something clearly disturbs / interacts with the warfarin cycle and so it is indeed wise to not "simply blindly" continue dose but monitor though it. Had I just contiued my dose I anticipate my INR may well have spiked over 4 or 5.

I think next time I'll cease a day earlier and resume as planned. After all one does NOT want a high INR during the healing phase of post surgery. One wants something akin to proper coagulation to assist the healing process at the start.

 

[Eva]

...
....
I think next time I'll cease a day earlier and resume as planned. ..?

This is what I did ... twice When I had a tooth extraction and at the time of the implant!