Bridging - 2nd time

mknuppel · Jul 30, 2012

I need to bridge for an upcoming procedure. This is only the second time. Stopping Coumadin and switching to lovenox and than back. I'll be at an INR level of 1.0 for about 24 hours. Should be in the 2.5 - 3.5 range.

I feel the folks setting up the schedule are not in sync when outlining the steps. I would think it would be a fairly "standard" process.

It is a worrisome period for me

Any specific questions that I need to ask or areas to watch?

I've already asked about performing the procedure without coming off of Coumidan - but that was a no.

Any comments would be greatly appreciated!

-MikeK

mainframe · Jul 30, 2012

Hi Mike,

I've had 4 surgeries since my 2nd AVR in 2009 and had to bridge twice. I never felt like it was a big deal, but then I've been through alot and don't sweat the small stuff. If you have a concern with the schedule the surgeon doing the procedure is giving you, check with who ever is monitering your INR. I have a Anticoagulation Management Service (AMS) that manages my INR and if I have a question they're pretty responsive. Good luck with your upcoming procedure.

AgilityDog · Jul 31, 2012

Standard bridging for mech valves is 1 mg lovenox per kg body weight, twice per day, after INR drops below 2. Then hold lovenox approx 16 hours prior to surgery.
Your INR usually drops below 2 about 2 days after holding coumadin if your range is 2.5 to 3.5.
Your INR should be monitored closely once you stop the coumadin, so you know when to start the lovenox.
At a weight of 132 lbs I used 60 mg of lovenox twice daily. If they only give you 40 mg syringes, they are dosing for A-fib, not mech valve.

chaconne · Jul 31, 2012

I also worry about having to bridge in the future as it seems I had a small blood clot go to my eye 1 week after my AVR Surgery. Does anyone know if there is a big increase in the risk of a thrombotic event during bridging that's done correctly?

mknuppel · Aug 7, 2012

I appreciate the comments.

Starting the bridging this week. Stopping Coumidan and starting the Lovenx shots every 12 hours. Stopping everything for ~24 hours prior to the procedure. Restarting Lovenox and Coumidan and stopping the Lovenox after I'm in range.

Sounds so routine - I hope it turns out that way.

Protimenow · Aug 7, 2012

Even though I had a stroke because my meter was reporting a higher INR than actual, I'm not entirely sure how often bridging is required. According to some research, if you're more than 3 months post-op, your INR can probably drop below range for a few days without causing problems.

In my case, I may have gone for more than a week in the danger zone.

Of course -- I'm not saying that you shouldn't trust your doctors. (BTW: it's spelled coumadin, not coumidan -- but it may be easer just to write 'warfarin.')