Blood Clot Post Surgery

[dwhist]

I was scheduled for a total knee replacement on Thursday Nov 5. I have had a mechanical valve for 9 years so I met with cardiologist for bridging. Note I bridged 3 times in 2017 with no problems. This was in the US.

Schedule was to take last does of warfarin on Friday and start testing on Sunday with goal to start Lovenox shots when I drop below 2.5. My range is 2.5 to 3.5. That happened on Monday when I tested 2.2 and I started the shots, one Monday, two Tuesday and only one the morning one on Wed. I was told nothing 24 within 24 hours of surgery. Went in on Thursday and had the surgery. Was told my INR at that time was 1.06. Thought in my head was that was too low.

Surgery went fine and I was in a room pretty quickly and day progressed.

Friday I do not remember much. Apparently a doctor came early in morning and tried talking to me. What he found was I was incoherent, slurring my words and face was droopy. He called a stroke alert and I was carted off. I do not remember this. My wife was called and told to get to the hospital as quickly as she could. I think they did a CT scan. Again I do not remember anything from that day. Next thing I remember is waking up on Sat morning in the ICU. They had given me a clot buster drug TPA that required I go to the ICU for 24 hours for observation.

On Sunday I was given an MRI. After words I was moved to a cardio floor. Neurologist came down and told me MRI did not show any damage, they caught it in time. Cardiologist came to see me and discuss what had happened. I thought it was a clot from knee work, but he said it was a clot that developed on the valve and broke lose. While I am now on Heparin drip, he will not let me leave hospital until INR is at 2.5 or higher using the Warfarin.

It seems as though clot developed overly fast and could have caused more damage.

Curious what others think or have experienced with bridging.

 

[pellicle]

They had given me a clot buster drug TPA that required I go to the ICU for 24 hours for observation.

good ... that's the best you can do ...

fingers crossed for an uneventful recovery

 

[slipkid]

Scary. Sounds like you dodged a bullet. Best wishes for speedy recovery.

One quick comment - As I understand it, when bridging from warfarin to lovenox/heparin I was told your INR no longer matters. That is that once you are on lovenox for the recommended time period and have ceased to be on warfarin your INR measurement will be close to normal or 1.0, but that the lovenox works against clotting in a totally different way, that is not measured like "INR". So your INR being 1.06 day of surgery did not put you at risk of a clot per se.

It is only when bridging back to warfarin and discontinuing lovenox that it is impt to get your INR to a target range via warfarin to minimize stroke possibility again.

At least that is what I was told last year when I had to have a cardiac catheterization done (which then led to me getting a stent put in). I was testing my INR every day when bridging to lovenox and concerned about my INR dropping and they told me to stop testing and stop worrying about it, that my measuring INR was basically a waste of time since that didn't measure anything that the lovenox was doing.

 

[tom in MO]

My mother in law had a similar experience. She had to come off warfarin for her tissue AVR and as a result had a stroke in post-op. They didn't know where the clot came from. She made it through OK.

 

[dwhist]

Thanks all,

I am still trying to get information on what happened. My wife said the cardiologist told her the orthopedic surgeon had put me on Xarelto, which he changed. He said it was a blood clot they started on the valve. I am seeing they did 3 CT scans on day of issue. One more day later and then an MRI that showed no lasting damage. I do not not remember the day of event. I see cardiologist nurse today and am going to see if she can tell me what anti-clotting drugs I was given after surgery. If she can"t, I will ask for full hospital bill that may show show me.

I am amazed that blood clot could appear in less than 48 hours and it supports need to really keep testing weekly.

 

[slipkid]

Thanks all,

I am still trying to get information on what happened. My wife said the cardiologist told her the orthopedic surgeon had put me on Xarelto, which he changed. He said it was a blood clot they started on the valve. I am seeing they did 3 CT scans on day of issue. One more day later and then an MRI that showed no lasting damage. I do not not remember the day of event. I see cardiologist nurse today and am going to see if she can tell me what anti-clotting drugs I was given after surgery. If she can"t, I will ask for full hospital bill that may show show me.

I am amazed that blood clot could appear in less than 48 hours and it supports need to really keep testing weekly.

Just a personal experience - you can't trust ANYBODY, Drs, nurses, hospitals, none of 'em. Mistakes happen. And unless you are sharp enough to catch it yourself you will never know. When I was in still in hospital recovering from heart attack/OHS one day a nurse came in and gave me a belly shot. I was still getting lovenox belly shots but transitioning to warfarin. I complained that I thought I just had a lovenox shot not long b4. The nurse said it was not lovenox.

Luckily one of my sisters was there in the room at the time who used to be a nurse, who had experience with dealing with her husband who went through similar heart surgery, and was watching over me, trying to be my patient advocate, asking questions, dealing with the Drs, all that stuff. She asked what I was getting a shot of. The nurse said it was vitamin K. My sister questioned that, supposedly it is not recommended/not considered worthwhile/risky or something to do that. The nurse said it was ordered by the doctor (I was still in the care of the surgeon & his staff). My sister made note of that to ask about it. Eventually we had a meeting with the surgeon's staff after I was discharged. She asked why did they give me a shot of vitamin K, that to her knowledge that should not even be done, and his reply was of total shock/surprise, agreed with her that it is not something that they do, it shouldn't be done, it wasn't ordered for me, and could have screwed things up with my warfarin etc. We never found out why I was given that shot and had so much else to deal with it fell by the wayside.