Here is a copy of my reply to Sandy Shields on the Heart Talk Forum regarding "Surgery Tuesday"
Personally, I would be very tempted to cancel the surgery at her local hospital and arrange to have it at a major Heart Center where they are equiped and knowledgable enough to handle any heart / anticoagulation emergency should it arise.
'AL Capshaw'
There are TWO primary alternatives to Bridging Therapy
BOTH require going OFF Coumadin 3 to 5 days prior to the procedure / surgery.
1 - Begin Lovenox Injections to the abdomen 1 day after stopping Coumadin and continue until 24 hours before the procedure.
Restart the Lovenox injections AND Coumadin the evening after the procedure (12 hours) OR as soon as the risk of bleeding is deemed safe to resume.
Continue the Lovenox injections until INR has returned to theraputic levels.
Your Cardiologist or Anti-Coagulation Manager should be consulting with the surgeon and provide the exact schedule, details, and TRAINING for 'self injection' of your Lovenox shots.
2 - Involves going in to the Hospital for a Heparin IV drip 3 to 5 days prior to the procedure, stopping 24? hours before the procedure, and resuming the IV drip once you are deemed safe not to bleed. Again, you will stay in the hospital, in the IV drip until your INR has returned to theraputic levels.
If I were undergoing surgery, I would want to be in a hospital that could tend to ANY and ALL Heart Related Conditions. I would NOT undergo surgery at a small local hospital. Just my thoughts.
Assuming you intend to proceed, please CALL your Cardiologist, tell him what is going on, and ask if he would consult with the Surgeon BEFORE you have surgery.
I would also have a frank discussion with the SURGEON about Bridging Therapy and INR just to get a 'feel' for how well he understands the issues. IF your are uncomfortable with his understanding, I would CANCEL the surgery. Again, just my (non-professional) opinion.
Best Wishes,
'AL Capshaw'
