Bridging on Arixtra or no anti coagulation at all?

[dr_gibberish]

Hi All. I am a brand new member and just found this site while looking for information about my current situation. What a great resource.

Anyhow, I have a carbomedics aortic conduit after an ascending aortic aneurysm repair about three years ago. I am considering some elective surgery (vasectomy) and this is complicated by the fact that I am allergic to lovenox. (Have tried it twice with very elevated liver function tests each time.)

My cardiologist has said that bridging is not really necessary and that I could go off coumadin a couple days before the procedure and start again the day after. He says that this is currently considered an acceptable process with this valve, even if bridging is preferred.

In looking this up on line I cant find anything saying that is acceptable, and lots of things saying it is a BAD idea. However, I have also seen several things about people with a similar response to Lovenox having a positive response to Arixtra (which I had never heard of before).

So my questions:
1) Has anyone else had procedures done with NO bridging?
2) Has anyone else used Arixtra to bridge?

Thanks in advance for the help!

 

[Lynlw]

I don't recall hearing about vasectomies and coumadin here before. Sorry this doesn't really answer your question,
I never paid much attention to vasectomies, but are they normally bloody? IF not I would ask if it is possible to just have a lower INR and not go off Coumadin. Would it be possible to look into some of the "no scapel /no needle" type vasectomies and see if that would be able to be done without stopping your coumadin?

 

[dick0236]

So my questions:
1) Has anyone else had procedures done with NO bridging?
2) Has anyone else used Arixtra to bridge?

Thanks in advance for the help!

I have no experience with either #l or #2. I had that done long ago, and before my OHS. I don't remember much bleeding, but there was some bruising and DISCOMFORT. I am with Lynn and would ask about lowering your INR without going off warfarin completely. Going off warfarin for couple days(2?) problably would not cause a problem, but ??????

 

[ALCapshaw2]

I asked 3 Surgeons about their Bridging Philosophy and got 3 different answers.

1 - Just go OFF Coumadin a few days before surgery then restart Coumadin that evening (a few hours after), knowing that it takes 3 days to start to become fully effective. NO Bridging.

2 - Stop Coumadin 3 or 4 days before Surgery. Start Lovenox (or Heparin drip if hospitalized) 24 hours after the last Coumadin. Stop Lovenox (or Heparin) 24 hours (sometimes 12 hrs?) before surgery. Resume Coumadin that evening (a few hours after surgery) with NO Lovenox or Heparin after surgery.

3 - Same as #2 but Resume Lovenox or Heparin sometime after surgery (8 hours to 48 hours, depending on Bleeding Risk vs. Stroke Risk assessment).

Sadly, there are NO standards established for Bridging. Most Surgeons just go with what they are comfortable using...

Be sure to have you Surgeon consult with your Cardiologist.

Are you also allergic to Heparin? That could be another option but requires hospitalization.

I'm not familiar with Arixtra.

'AL Capshaw'

 

[dr_gibberish]

No, not allergic to Heparin, but then i would probably be in the hospital for at least 4-5 days for a procedure that normally takes an hour.

As far as bleeding being a problem, I think it is not generally, but severe bruising is. I think big hematomas are the most common complication, and clearly being on blood thinners would make that more likely. l am just anxious about being off coumadin entirely for several days...

 

[Bina]

My husband is not on Coumadin, but he had a V many years ago, and his only complaint was localized soreness for which the doctor told him to take a Tylenol and "Park a quart of cold beer between his legs".
Ah, the good old days.....
I would ask your doctor if you can procede with a lowered INR in the area of 2.0----2.5

 

[dr_gibberish]

Thanks for all the thoughts. FYI, my target INR with this valve is 2.0-3.0 anyhow, and I have been trending toward the low end of that range regardless. I did some more research on Arixtra and it seems that it is a very expensive med (even compared to lovenox) and that may be why it is not used often. But it seems like it can be used to bridge like lovenox, and people who have a bad reaction to lovenox and other related meds can use it. I am going to check with my cardiologist to see if that is an option and report back. Thanks all.

 

[dr_gibberish]

So just to update the last post, I asked my cardiologist about this and he said he had no experience with this Arixtra. It must be pretty rare, as he is the head of cardiology there and generally a pretty on top of it guy. I am still doing research and will see what else I dig up.

I am also curious whether anyone else has heard of simply going off coumadin with NO bridge. I think this recommendation may be specific to my bi-leaflet Carbo Medics valve, but I cannot find any information about the risks of doing this.

 

[Cris N]

I've had two surgical procedures at 2.0 - my surgeons were fine with that.

 

[camgough]

I haven't seen any recent information of Coumadin and vasectomies, but this is something else that is in my mind. Has any guys had a vasectomy after having AVR and while on Coumadin?