Angiogram while on Coumadin

[Lorraine]

Hi Everyone,

Sorry I haven't posted in a few months. My postings tend to be sketchy at best in the last year or so. Up until last month I had a lot of computer problems at home. I finally got a new computer but I still never have enough time to post. Not enough hours in a day. Of course I always read the new post on vr.com before I start work in the morning so I know whats happening and who needs prayers. So everyone is always in my thoughts and prayers even if I don't get a chance to post.

I am checking to see if anyone has had an Angiogram done while they were on Coumadin? I am to have an Angiogram done next Wednesday. I thought for sure I would be bridged, which is not the case. The nurse said they would not take me off my Coumadin for either an Angiogram or Colonoscopy. She said there would be too much risk with me having two mechanical valves. Instead we just need to get my INR down to 2.0 by Wed. So the plan is.....

On Friday I will get my INR checked. From there they will lower my dose some (not take me off it) and then they will check it again on Monday or Tuesday. I take 8.5 mg a day. I never got a clear cut answer about what if the INR isn't at 2.0 on Wed, if they would reschedule. I plan to ask that tomorrow when I go in.

So my question is if anyone has had this done and what was the procedure their cardio office followed.

I had the angio done before but of course at that time, I wasn't on COumadin yet. Any info would be extremely helpful. Thanks!

 

[ALCapshaw2]

Hello Lorraine,

It sounds to me like your Doctors are 'up to date' on Coumadin Management and Risk Balancing. Doctors / surgeons are becoming more aware and concerned about Stroke Risk vs. Bleeding Risk. I even had a cyst removed by a surgeon while anti-coagulated. HE did NOT want me to take the Risk of Bridging. We did have to deal with some bleeding but he got it under control and it eventually healed OK. Just remember, "Pressure and Time Heals all Wounds". (I just made that up!

When I last had an angiogram, the did Bridge me. While I was in the hospital, my arm was SEVERELY BRUISED by an automatic Blood Pressure Machine that went to FULL PRESSURE after an erroneous reading. Foolishly, I did not rip it off immediately, but waited for it to go down on it's own. My entire arm from shoulder to wrist turned PURPLE!

Bottom Line: Don't let anyone or any machine allow the BP cuff to go much above your known BP level and if it does, RIP the Cuff OFF your arm.

Now to your real question. I have heard of angiograms being performed ON Coumadin at major hospitals. Just be sure everyone on the cath team knows you are still anti-coagulated and what to do, especially the Recovery Crew. With an experienced crew, this 'should be no big deal'. You may want to discuss this with your Cardiologist some more if you are still concerned.

Good Luck!

'AL Capshaw'

 

[Lorraine]

Al,

I remember when I posted in April about my ER experience with the blood pressure cuff, you told me the story then about your experience.

Oh you better believe after having a ring of bruises around my whole arm because of that blankety blank cuff being too small and the cuff mal functioned on me, I will definitely Rip it off ASAP if that happens again! I did the last time and of course that nurse wasn't too happy with me. Hey it sure wasn't her arm being squeezed to a pulp!

I do feel my doctors are up to date on Coumadin Management but I guess since it is an Angiogram I'm apprehensive about the bleeding factor. I know after the procedure they do it a little different than when I had it done 7 years ago. 7 years ago after the procedure, I had to lie on a slant with a weight on my groin for 6 hours to make sure the bleeding stopped and coagulated before they would let me leave. I guess now they use some type of plug and you only have to be that way for 4 hours after the procedure.

I do plan to ask more questions at my cardio office. I did ask them if they planned on having pints of blood handy in case I kept bleeding. Oh believe me, I will make sure they know I'm still on Coumadin, my family will make sure they know too. We won't let them forget that for a minute.

Thanks for your input! I'll post my INR tomorrow and tell you what they tell me to do as far as dosing down. Then you can tell me if you agree. I'll tell you if I agree. Thank!

 

[Kathleen]

I have had to drop my INR on numerous occasions for different purposes. I had the number 2.0 also and found it is a number and they have wiggle room with it....2.2 works so does 1.8. They will probably do one just before the procedure so if it is not 2.0 it more than likely will be the morning of. I found getting it back up was the tough part. Good luck with the angio.
Kathleen

 

[Lorraine]

Hi Kathleen,

Thanks for your response. How many days before your procedure did they change your dosage to start dropping your INR? How much of a percent did they lower it? Just curious. I know that each person will be different depending on how fast or slow they metabolize Coumadin. I'm just looking for a ball park figure. As to bringing it back up, yeah, I know that's the worse. For the last couple of months I've been stable, last month 3.4 and just last Friday, 3.1. Perfectly in range even though I prefer on the higher end. I thank you for your help. Was one of the reasons you had to lower your INR, to do a Angiogram? Again just curious of the difference in the clotting factor time of the plug while on Coumadin,verses when I had it done in 2000. Again I thank you for your input.

 

[LUVMyBirman]

Angiogram Lorraine.. Sure hope all will turn out negative.

I know you have been having a rough go of it. Did you ever consider GERD? Telling you...it can feel like bad chest pain. Been there. To my embarrasment went to the ER with it, thinking I was having an event. Well..at least it was nothing serious. Severe GERD can give off symptoms similar to a cardiac event.

You are in good hands with Midwest. Liked that they would leave us on for a colonoscospy as well! Where are you having your proceedure?

Take care my friend. I will be scarce for the next few weeks. Though...I will check my email every few days. Keep me posted.You will be in my thoughts and prayers!

 

[geebee]

Lorraine,

My last angiogram (in 1994) was done with an INR of 2.8. I had no problems. Be sure and have your cardio communicate with the cath lab nurses ahead of time that you will be anticoagulated. When I went in for my cath, the nurse said the cath would not be done based on my blood test. When my cardio came in, he told her it would be done and there was some unease between them so prior communication can prevent that.

The nurse also said she would not be responsible for after cath bleeding prevention (she was a bit of a tyrant) so my cardio stayed and kept pressure on the site for over 2 hours when they switched to the sandbag. I think they use plugs now but this was a while ago.

They will probably keep you flat for longer than others. I had a foley catheter and it was so much better than trying to pee lying down. If such things do not bother you, this is something to consider.

Hope things turn out well for you.

 

[Kathleen]

Lorraine
The last time we lowered it it was to do an angio that resulted in piggy backin gone of my stents with another stent. The plug removal was rather difficult it took a long time but the nurse said she had hours to do it. She removed it little by little adding pressure each time. It took close to an hour and I was grateful she suggested a pain killer upon removal since you had to lie very still and it was sore so ask about that before they take it out. I take 3.0 per day and have for years, before that it was 2.5. I cannot for the life of me remember how we titrated the coumadin. I should since I have done it so many times. I know I did hold one dose in the three days prior to the event. I did not worry about going to low since they would be ready with the heparin as soon as I was done. I have lowered my INR at least a dozen times for procedures and surgery. I was not a home tester when I did any of those. Are you home testing? How soon will they do the angio and how have they said they will drop you? Is this your first time off the coumadin? If so don't worry they will watch you closely. If you need any more info please let me know
Kathleen

Hi Kathleen,

Thanks for your response. How many days before your procedure did they change your dosage to start dropping your INR? How much of a percent did they lower it? Just curious. I know that each person will be different depending on how fast or slow they metabolize Coumadin. I'm just looking for a ball park figure. As to bringing it back up, yeah, I know that's the worse. For the last couple of months I've been stable, last month 3.4 and just last Friday, 3.1. Perfectly in range even though I prefer on the higher end. I thank you for your help. Was one of the reasons you had to lower your INR, to do a Angiogram? Again just curious of the difference in the clotting factor time of the plug while on Coumadin,verses when I had it done in 2000. Again I thank you for your input.

 

[Lorraine]

Gina: I looked up the symptoms to Gerd and the pains I get in my chest on the left side, are nothing like that, that I can tell. Thanks for the suggestion. I try to pay attention when I get them, but sometimes just bending down to pick up a pencil off the floor, will give me a twinge. I'm having the Procedure done at Good Shepherd Hospital in Barrington. They have their own Cardiac Wing there now. & years ago I had the Angio done at Sherman Hospital in Elgin. Yes it is nice to know that they won't take me off for a colonoscopy either. I hadn't gotten one done yet because I was afraid they would have to take me off Coumadin. Thanks for the prayers. I'll email next Thursday if I'm home by then.

Gee Bee: I believe also Gina! Thanks for some useful info. I do plan to make sure that everyone around is aware that I'm coagulated. Interesting that they did your Angio with an INR of 2.8. No wonder my cardio's nurse didn't seem too concerned about reaching 2.0 exactly. I guess this is just a ball park figure? I would have figured to bring my INR down to what it needed to be for next Wednesday, they would have started me lowering my dose at least a week before. That's not the case. I will go in today and have my INR checked and then they will adjust my Coumadin down. Knowing how I drop when I have forgot to take my Coumadin or have held a dose, I don't think they would want to lower my dosage too much. I'll know more today when I go in. But you said the cath would not be done based on your INR, so that sounds to me like unless the INR is unusally high, they would do it anyway?

When I have the angio done, I have a funny feeling I may be there overnight. Like you said it will take longer to stop the bleeding. I sure hope a nurse or my cardio stays with me and watch me diligently, to make sure I stop bleeding. I did ask them if they were going to have pints of blood ready in case I lose too much.

Yes, the first time I had the Angio they used sandbag. The nurse did say they would use the plug. Hope it's effective! Good suggestion about the foley. I'm not a huge fans of those, but it would sure beat trying to get my butt over a bedpan while trying to remain straight! I'll keep you posted as to what happens.

Kathleen: After reading your post, I'm preparing in my head that I'll be there overnight. The plug sounds tedious to take back out and still keep the incision from bleeding again. I am having it done Wed, Aug 8th.

I have finally gotten a machine to home test but I've been having problems getting blood to flow after I've pricked my finger with the lancet. I've tried a couple of different ones, I;ve tried running hot water over my fingers, shaking my fingers violently to get the blood to flow. About every third time I might get enough blood to flow to test on the machine. I will try again to test at home, as they lower my dose to keep an eye on the INR, but I will go back in for testing to my cardio office either Mon or Tues of next week. I find out more info today. Yes, I am nervous, even though I won't totally be off Coumadin, but just to have my dose lowered for a few days is scarey. It is reassuring to hear from members that have gone through this (that's the reason we all love this forum )and can share their experiences. If I can think of any other questions, I will defnitely post.

Thanks for all the reassurance that I will be watched closely during and after the procedure. I am certainly hoping they will. You all have given me some great suggestions and info I will be able to use when questioning my cardio's nurse. Thanks a lot. I will post tomorrow the plan of action from tomorrow until next Wed. I will then post after I get back home, which may not be until Friday. I plan to be at my sisters for a day after the hospital.

 

[Guest]

Just hope they do not try to do an angiogram with the colonoscopy equipment

 

[Joe]

Lorraine, I noticed you say you have problems getting enough blood in the cup for testing! I also had the same problems. I solved it by wrapping an electic heating pad around my hand for about 30 minutes before beginning the test and then milking the hand and finger. Pain to do but works for me!

Good luck with your procedure next week, hope all turns out well.

I am glad to hear the medical guys are starting to do more tests with patients being left on coumadin and not having to bridge. I for one have had enough belly shots of lovenox recently to last for me for years!!!!!!!!!!!!!!!!!!

Again , BEST WISHES, JOE/MO

 

[ALCapshaw2]

Lorraine,

A few more tips for getting blood from your fingers.

First, be sure you are sufficiently hydrated beforehand. Drink a large glass of water before (an hour? or two? or??)

Second, run Warm Water over your whole hand and maybe even your wrist.

Third, swing your arm in a 90 degree vertical arc (45 degrees forward, then 45 degrees backward), Back and Forth, several times. Be Careful not to hit anything !

Fourth, run some more Warm Water overy your hand and fingers. Then 'stick'.

Good Luck.

'Al Capshaw'

 

[sue943]

When I was in St George's with my endocarditis the woman in the next bed was being bridged for an angiogram. She was attached to a drip for days. She didn't have valve problems though, her problem was blocked arteries.

 

[Lorraine]

Al: Yeah sure hope hope they don't use the wrong equipment! I think that would hurt, don't you!

Joe: Thanks for the tip. I'll try the heating pad. it can't hurt. I was glad to hear they wouldn't bridge me unless they have to. I'll get to that a little later in my post.

Al2: Thanks for some more tips on trying to get enough blood. I never thought about real hydrated. I will make sure I drink a glass or two of water an hour or so before I'm going to test. I have ran warm/hot water over my hands (though I never included the wrist) Another trick to try! I have dangled my hands and shook them, and tried to milk the hand. I will try the tips everyone has mentioned that I haven't tried yet. It's frustrating that I finally got a machine but haven't been able to prick my finger and get a sufficient amount of blood. As soon as I can do it proficiently, I'll only have to go to the clinic every few months to get my INR done. I'll be able to call it in from home when I'm suppose to test.

I went for my INR yesterday and it was 2.4. My cardio nurse said that she wasn't going to lower my dose, because they didn't want it to drop too low. Instead, she said just take my regular doses until Monday and come back. She said she keep eating and drinking what I always do. So Monday, if my INR is around the same they probably won't do nothing. If my INR is higher they will have me hold Monday's dose (they didn't mention to me about Tuesday yet.) Now if my INR goes too low then they will want me to take Lovenox shots once Monday night and twice on Tuesday. Then I'll come in Wednesday morning and they'll do the Angiogram.

I want to thank everyone who have helped answer my questions. I feel like a newbie with all the questions. I guess with each different things we go through that we haven't already had done, we'll always have questions. I had an angio done before, but not while on Coumadin. I'll keep everyone posted. Thanks!

 

[Lorraine]

I went for my INR today and it was 2.2. The first thing the coumadin nurse said was that I was to start bridging today, per my cardios orders. I talked to a different nurse who works for my cardio, than the one who I had been dealing with. I have to give myself a 70mg injection in my stomach tonight, and then two tomorrow(12 hours apart) and none on the morning of the Angio. Wed night after the angio and I go home I am suppose to inject myself & Thurs I should also inject 2 each day and also take 15mg of Coumadin. I normally take 8.5mg a day. The other tricky thing is comes in 80 mg syringe and they said i have to let out 10mg so i only get 70. Easy for them to say, they give shots all the time. The first and only time I gave injections was to my cat last year. I guess I did okay with her.

I am upset because I thought I wouldn't be bridged at all if I was on target. I guess they are afraid I will drop too low day of? I went from 2.4 to 2.2 since Friday and I even had my usually couple of beers a night. I do have a voice message into the nurse I was originally dealing with, but I figure by 5pm I better inject myself.

Any easy tips to do it? They told me what to do but I'm scared anyway. Do all these instructions sound right to those of you that have bridged? any help would be appreciated. Thanks!

 

[ALCapshaw2]

Lorraine,

Were you able to reach the orignal nurse who consulted on your anti-coagulation management for the cath? (or the Cardio?)

The best way to be SURE of having 70 mg is to 'push out' 10 mg BEFORE injecting. The Down Side to this is that the 'air bubble' is gone and there is likely some Lovenox residue on the tip of the needle. That can cause 'bruising' at the surface where you inject.

Another approach is to inject only 70 mg, leaving 10 mg in the syrringe. That saves the 'air bubble' and results in less bruising but is harder to do.

If you don't have a lot of excess "Belly Fat", it helps to 'pinch' your belly to 'bunch it up' at the target site. I had a hard time making myself 'throw' the needle like a dart and would hold it just barely above (or just barely touching) my skin and then "Push it in" fairly quickly. (I can't believe I'm admitting that in public!). Using a "dart throwing technique" is Definitely the PREFERRED method. Having someone ELSE do it is also an acceptable approach. I just wanted to be sure I could do it on my own for those times when no one else was available.

'AL Capshaw'

 

[Lorraine]

Hi Al,

Yes, the original nurse called me back. she was upset because the other nurses didn't summons her when I was there. I did ask for her too. She aplologized because she didn't make herself clear to me last Friday. She said if I was in my theraputic range 2.5-3.5 they wouldn't bridge, but hold my dose on Monday. Since I was 2.2 the doctors orders was to bridge. She also said that if she would have seen me, they had dummies there that I could have practiced on and she could have shown me exactly what to do.

She did walk me through the whole procedure over the phone though, while I did it. She explained the way you did, about how to gid rid of the 10mg of extra lovenox. It went fine, but I did bruise even though I heard the swish at the end when I was done injecting. I didn't really use the dart approach. I just cleaned the site, squeezed some fat(yeah, I'm admitting that in public to ) and push the needle in and pushed down on the plunger. She even explained how to push and get the cover to cover the needle up when your done to dispose.

This morning I did it easier and faster and no bruising. The first one still has a little blood oozing from it, not much but according to the instructions thats to be expected. The second one, no bruise at all.

I think what helped to give my self the injection was remembering what I did last year when I was trying to keep my cat KC alive and I had to give her those saline solutions injections. I was nervous the first time I did that too thinking I was going to hurt her or I was going to inject her in the wrong place. I did fine,she didn't even flinch. she did only lasted a few more weeks due to her kidneys. So though it wasn't a great memory to think about, it was an experience I had to do for my cat, that help me to do what I had to do for myself.

Thanks for your input. I have to give myself one more today, and then tomorrow night after the angio and also twice on Thurs and Friday morning. Then I have another appointment Friday afternoon. I just have to find enough spots on my stomach to inject. I'll post when I can after the procedure tomorrow to let everyone know how it went. Thanks again.

 

[Kathleen]

I for one will be looking forward to seeing a post that the angio is done. Sending thoughts your way.
Kathleen

 

[Lorraine]

Hi everyone,

I just wrote a great post that took me about a half hour to do, just to loose it when I went to post. I'm frustrated now, so I am going to do a word document and then copy and paste it here. I guess when you take too long to post, you get kicked off?

Angio was scuccessful and i have the arteries of a teenager according to the cardio that did the procedure. I'm going to rewrite what i originally posted and will post again later. Just wanted to at least respond a quick note to let you know I'm okay. I'm just so frustrated with losing the post i just tried to post before this. I'll write later.

 

[Lorraine]

I?m Home! There?s no place like home!

Angiogram went wll. The cardio doing the angiogram said I have the arteries of a teenager! Now that?s a compliment! The site of my incision looks good. They used the collagen plug to close up the incision. It looks great. I had the procedure at 9am and I was able to go home (well to my sisters house) by 2pm. No pressure closure or sandbags like my first angio 6 ½ years ago. My expreince with my nurse for the day, is another story in itself. I just wanted to let everyone know at least as far as the angiogram I look good.

My instructions on leaving the hospital was to keep shooting my Lovenox and take 15mg of coumadin on Wed and Thur, drink plenty of fluids and see my INR nurse on Friday. I went to my sister?s house and was really just kinda out of it the rest of the day. Kept leg elevated as instructed. Thurs I decided to take my own INR with my machine and it was 1.1. I was kinda scared but since I was being bridged I figured it was okay.

Friday I went for my INR and it was 2.0. I was told to give myself the Lovenox shots until Sat night. Friday I was to take 15mg of Coumadin and then go down to my regular dose of 8.5 for Sat and Sun and come back for my INR on Mon.

My stomach is a mess of bruises, the worst one being on my right side where I gave myself the first Lovenox shot. The whole right side of my stomach is bruised and slightly swollen. I did the next three days of shots on my left side. I got the procedure of giving myself lovenox shot and it doesn?t even hurt. A little stinging if I didn?t let the alcohol dry long enough, but no problems. My stomach hurts worse than the incision for the Angiogram when I?m just sitting. I?m walking better and better each day, but am taking it easy. My cardio?s nurse said Friday that I could just leave the bandaid off on the incision for the angiogram, it looked that good.

I am to see my cardio for a follow up in 4-6 weeks. I gave the nurse the CD of my procedure to give to the doctor. If I had been at home I would have downloaded a copy onto my computer. I didn?t come home until after the procedure. It felt good to sleep in my own bed!
I noticed a thread honoring Nancy being such a advocate for Joe. She had to be for good reason and she was one smart cookie to know that. I want to reiterate how important it is to be your own advocate and always have someone with you. My nurse taking care of me the day of the procedure (who was suppose to know that I had two artificial valves, that I take coumadin, that I was bridging) was clueless. She wasn?t a bad nurse as far as knowing her normal procedure to get you ready for the angio, but as soon as I threw a monkey wrench into her procedure she wasn?t happy. She didn?t have the best bedside manner either. I had told her I wanted the non allergenic elctrodes tabs and also a bigger blood pressure cuff. I had also had told my nurse at the cardio office to make sure that?s what I wanted, plus I talked to a nurse from the hopital the day before the procedure and told her my same request. They had ample time to have those items there. So of course she was flusterred trying to locate the items. Then?

How would you like that the first question she asked me was ?Why are you on Coumadin?? WHAT! I was on full alert then. She obvious just thought she was taking care of a routine patient coming in for her first angiogram. I went kinda ballistic to put it mildly. She couldn?t have even read my chart or history(which I know my cardio nursed faxed over to the hopital, even down to the type of valves I had and the size. This was the woman who after the procedure was suppose to be watching to make sure I didn?t hemmorage. Well I very crisply told her if she had read my chart she would hae known why I was on coumadin, that I had two not one artificial valves and that I was presentlly bridging. She was apologetic but that certainly didn?t make me feel any better. I told my two sisiters that were there, to watch everything she did and make sure she was doing the right thing. She went to put an IV in my arm and of course would she listen to me? I have very small veins, and they always wiggle unless you use hot compresses. So she proceeded to keep slapping the vein on my hand to try and get thevein to pop up, she thought she had it and of course the vein wiggled away and she kept digging. I said F---! So loud. She started to look at my other hand and I adamantly told her there was no way she was going to try that hand and get someone else to get the IV in me. Another nurse came over listened to what I said)imagine that) and got the vein in my arm on the first try after she used hot compresses. I think my assigned nurse finally realized I knew what I was talking about and was very humbled the rest of the time dealing with me.

So bottom line is never but never have your guard down. I want to thank everyone for yourhelp getting me through all this. I still don?t know what?s causing the occssional chest pains, but I will discuss that with my cardio when I see him. I hope Mon my INR is in range and stays there. I?ll keep you posted.