Bridging Therapy

[Karlynn]

She said there is a slight risk of bleed from that clamp that is used but that it's really a miniscule risk.

It seems going off Coumadin for a uterine ablation is starting to sound more and more like a dentist who won't do a single tooth extraction on someone that's anticoagulated.

 

[Guest]

I just received an e-mail from a woman who has antiphospholipid antibody syndrome. (These people are really high clotting risk because the antibodies cause their body to interpret their blood vessel walls as a foreign object and to try to clot them off.) Her doctor took her off warfarin and used Lovenox bridging.

I'm going to make a page about this on my website. If anybody would like to send me a e-mail about their experience or their doctor's advice, I will work it into that page. Let me know if you want your name used or not. If you want credit, let me know how you would like your name to appear (first name only, first name and last initial, or full name etc.)

 

[Karlynn]

I guess it's the doctors saying that with uterine ablation there is a slight risk of bleeding do to clamping the cervix, that gets me. My gyne said I wouldn't need to go off Coumadin for just a uterine ablation (It's the D & C hysteroscopy I'm trying to find out about now, since that's in my future.)

Why are they getting so concerned over something they consider "slight risk"? Once again - do they really fear that someone is going to bleed out through a small nick in the cervix? I've almost sliced off 2 knuckles while on coumadin and didn't come close to bleeding out - passing out maybe - bleeding out - nope.

Unfortunately for we Coumadin ladies - this is a fairly new procedure that is now being used more and more. Since it is a procedure that stops heavy bleeding, I'm only guessing that more and more women on warfarin will be looking into this procedure.

 

[Creed3]

Had My Uterine Ultrasound!

Had My Uterine Ultrasound!

Everything went smooth. I was in and out in a half hour and that was including going over questions. I am there longer for my PAP test. The procedure wasn't uncomfortable at all. Pretty much the same as getting a PAP or an intravaginal ultrasound when you are pregnant.
He told me that if I have the ablation done in the office, which is what he would like to do if they get the equipment, he wouldn't need to clamp the cervix because they would be using a freezing tool, not the hot water method. He also told me I wouldn't need to come off coumadin with the freezing technique. He also said there was no chance of damaging the fallopian tubes or lower intestines with the freezing method.
He did tell me that if he were to us the hot water ablation, that would need to be done in the hospital. We discussed how much the cervix can bleed. He indicated to me that the clamp could cause a lot of bleeding and it would be easier to treat that in the hospital. He also mentioned numerous needle punctures that could cause a lot of bleeding with the hot water method. I guess the needle punctures would be where they would be numbing me. It didn't sound to me like I would bleed to death or anything like that but that it would be easier to handle in a hospital setting. He told me to talk with my pcp and my cardio and that he will contact them as well and they will advise me as to the best way to approach the ablation if I can't have it in the office while still on coumadin.
It seems to me that if I have to have the hot water ablation in the hospital then I get the choice of staying on coumadin, using heparin or lovenox.
I'm keeping my fingers crossed that my gyn office gets the machine to do the freezing ablation. They will let me know in about a week if they are getting the equipment in the office. I still have a lot of things to go over with my pcp and cardio before I make the final decision on what to do.
I hope this helps some others who are thinking about having a uterine ablation done.

Take Care!
Gail

 

[Sherry]

Wow, Gail, this is interesting. My gyn emphatically said yesterday that the clamping procedure is really nothing to worry about (bleeding-wise) and would not take me off coumadin, if that's the procedure I chose. It's amazing how we are getting such different info. She was really interested in this website and what all of the women discussing this procedure were hearing from their own gynos. She readily admitted not doing this to other women on coumadin and was just open to other opinions, but still felt it unnecessary to take me off. I'm just so glad to have this forum and access to you all.

 

[Karlynn]

Gail, I'm glad you got positive information. My gyno doesn't use the hot water either. He said he doesn't believe it is as successful as the others. The one he uses is electrical current. They put in a mesh. I was near to getting a bit freaked out about the saline ultrasound - but I had the same experience you did - no biggie!

Sherry, I'm with you, it is very confusing to have so many differing opinions. My dr. spoke like the cervix, if it bled, wouldn't bleed much.

 

[Creed3]

Hi Ladies!
My gyn told me today that when he has done cervix clamping and needle injections on women not on coumadin, some of them have bled quite a bit. That is why he is saying me being on coumadin just elevates the chance of even more bleeding. Again, he didn't indicate that it would be a bleeding to death type of scenerio. Just that it would be easier to handle if I was in the hospital.
He even told me that he has had some women complain of a lot of pain and even fainted during the uterine ultrasound. He was going to prescribe me a painkiller to take before the procedure but I told him I would just take tylenol. I guess every person reacts differently but I didn't find it to be an issue at all. Very quick, simple and no pain.

Take Care!
Gail

 

[Guest]

I'm probably going to make a new page for my website next week about this. If anyone would give me permission to use their experience, I'd appreciate it. I will not use your name if you prefer or will use any form of your name that you like. Please let me know.

I had a freezing procedure for my prostate cancer 18 months ago and I can tell you that it was a piece of cake compared to what I see guys going through with surgery. If I had owned my own business, I probably would have gone back to work on Monday following the Friday that I had it done. But I had sick time, so I took it.

 

[Creed3]

Al

Al

Sure, you can use my experiences for your website. Any and all information that can be put out there is great. You can use my first name.

Take Care!
Gail

 

[Karlynn]

Al, I'll certainly let you use my experiences - once I found out what they are going to be.

I'm glad you are going to do a page on this. I'm thinking that more women may want to consider a uterine ablation BEFORE valve replacement surgery, so they don't end up in the situation that Sherry, Gail and I are in right now. As we approach menopause bleeding does become heavier for most women and warfarin just exacerbates the problem, not only with the bleeding, but when you need to do something about it. Or you may be like Gail and just have problems well before menopause. Either way, at first blush, it seems like it would be something that women may want to consider and discuss with their doctors.

 

[Guest]

Gail

Gail

Your information has been included on my new page
http://warfarinfo.com/uterineablation.htm

 

[Karlynn]

Thanks for starting the page Al. It will be interesting to see how it evolves as we learn more from experiences.

 

[Creed3]

I spoke with my pcp!

I spoke with my pcp!

I had my six month checkup with my pcp. We talked about the uterine ablation. He is hoping that my gyn will get the equipment needed to do the ablation in the office. That way I won't need to come off my coumadin.
He did indicate to me that if I needed to have the ablation done in the hospital that he will suggest bridging with Lovenox. I asked him if I would be able to just lower my INR slightly for the procedure and stay on coumadin and he said no. I either stay on coumadin or go off of it. My INR lately has been running around 3.0. I used to be at about 2.3 or so. My pcp said he will contact my gyn and they will discuss what is best to do. I let him know that I really wanted to stay on coumadin if I needed to have the hot water procedure done in the hospital. He seemed to continue to lean towards Lovenox bridging. When we discussed the amount of bleeding and chance of throwing clots and causing strokes, he said that yes either could happen.
I really hope that I am able to have the freezing procedure done in the office, then I don't need to even worry about it. If I have to go into the hospital for bridging, I don't know what I will do. I may just decide to wait and not have it done. I think I will give my cardio a call and see what he thinks. It can't hurt to get three opinions. I'll keep you all updated as things continue.

Take Care!
Gail

 

[Guest]

I was at a dinner meeting last night where the speaker was a doctor who has specialized in anticoagulation therapy. After the program we had a chance to sit and talk about a few things. When we were talking about bridging therapy, she raised a point that we have overlooked in our discussion here. Unfactionated heparin, the kind that you get by IV drip, is far from the ideal way to bridge because it is so hard to get the correct dose. After 24 hours on the drip about 40% of the people will still not have a level high enough to offer much, if any, protection. About another 10% will have levels high enough to make the risk of bleeding very high. Only about 1/2 of the people on heparin drips will be protected from a clot with low risk of bleeding after 24 hours.

Even though Lovenox, isn't and probably never will be, FDA approved for bridging, it is much more predictable. Almost 100% of the people who have their dose calculated on their actual weight will have full protection after 4 hours. We now know that people who have reduced kidney function need to have their Lovenox dose reduced and there are charts showing how to do this. Almost all of the reports of serious bleeding with Lovenox, we now know, occurred in people with poor kidney function. Using this new method, the risk of serious bleeding will be almost 0%.

Remember that neither unfractionated heparin nor Lovenox has been approved for bridge therapy and it is unlikely that any study could be done to satisfy the FDA as proof of safety and effectivemness of either method.

 

[Karlynn]

I was at a dinner meeting last night where the speaker was a doctor who has specialized in anticoagulation therapy. After the program we had a chance to sit and talk about a few things. When we were talking about bridging therapy, she raised a point that we have overlooked in our discussion here. Unfactionated heparin, the kind that you get by IV drip, is far from the ideal way to bridge because it is so hard to get the correct dose. After 24 hours on the drip about 40% of the people will still not have a level high enough to offer much, if any, protection. About another 10% will have levels high enough to make the risk of bleeding very high. Only about 1/2 of the people on heparin drips will be protected from a clot with low risk of bleeding after 24 hours.

Even though Lovenox, isn't and probably never will be, FDA approved for bridging, it is much more predictable. Almost 100% of the people who have their dose calculated on their actual weight will have full protection after 4 hours. We now know that people who have reduced kidney function need to have their Lovenox dose reduced and there are charts showing how to do this. Almost all of the reports of serious bleeding with Lovenox, we now know, occurred in people with poor kidney function. Using this new method, the risk of serious bleeding will be almost 0%.

Remember that neither unfractionated heparin nor Lovenox has been approved for bridge therapy and it is unlikely that any study could be done to satisfy the FDA as proof of safety and effectivemness of either method.

Al - is there any correlation between the amount of Coumadin someone takes and the amount of Lovenox they need for the bridging to be affective?

Thank you for continuing to pass on what you learn.

 

[Guest]

No. Lovenox is dosed on a purely weight basis, except when someone has moderate to severe kidney failure.

 

[Sherry]

She's pretty awesome, Rachel. My general practitioner is a good guy too. They both listen to me, and that's sometimes rare in the realm of doctor patient relationships.