Bridging Therapy

[metronome]

I know this has been touched on in other threads. However, I would like to hear about other members experiences coming off warfarin and bridging with Lovenox (low molecular weight heparin) for various surgeries and procedures (colonoscopy, endoscopy).
I dread the day I will have to face this. Thanks in advance.

 

[dick0236]

I know this has been touched on in other threads. However, I would like to hear about other members experiences coming off warfarin and bridging with Lovenox (low molecular weight heparin) for various surgeries and procedures (colonoscopy, endoscopy).
I dread the day I will have to face this. Thanks in advance.

Maybe you will never have to face this. I have never had to "bridge" for any procedures that have been done during my years on warfarin.....but I have been fortunate and have needed no serious surgery that required bridging. I have known of others who have "bridged" with little problem.

 

[Protimenow]

Bridging may not be all that bad. The only time I bridged was following a TIA that I had in April -- the TIA was because my INR was lower than my meter reported it (and because I didn't increase my dosage when the INR appeared to be at bottom of range. My INR, taken at the hospital after my TIA was 1.7. I was discharged, taking a higher dose of warfarin, but told to bridge for a few days to compensate for my already low INR.

Sure, injecting Lovenox (or, in my case, the generic) into my abdomen was a bit of a pain -- but it wasn't all that bad. Fortunately, I only had to do it for a few days.

Depending on your procedure - and your doctor's requirements for bridging (or not), you may not have to bridge. In my experience -- and according to some protocols -- it's probably safe to be below 2.0 for a couple days. Of course, if you're having surgery, the surgeons probably are much more comfortable with minimal blood loss.

 

[metronome]

Thanks for the feedback. I could be facing surgery to remove a cord lipoma and another lipoma in a thigh muscle (adductor magnus). We've been "watching" them both for about 7 years now. As long as the stay lipomas and not liposarcomas, they can stay.....
Now, where is that soft tissue cancer website

 

[MarkU]

I've done Lovenox bridges four times in the past twelve years in order to have colonoscopies. It was a bit of an adventure the first time as I learned how to give myself the injections with the pre-loaded syringes, but no big deal. It's easy once you get the hang of it. The normal procedure is to do the shots every twelve hours for three days prior to the colonoscopy after stopping the Coumadin , and then for three days again after starting the Coumadin again until my INR got back in range.

I've had a couple of dental procedures where my dentist discussed things with my Cardiologist ahead of time, but in the end everyone just agreed to just reduce or hold my Coumadin for a day or so and not bother with the bridging.

I did have one dental surgery where the dental surgeon insisted I go off Coumadin completely. My cardiologist disagreed and when he couldn't convince the dental surgeon otherwise, toid me to just lie to him about it. Everything went smoothly and nothing further was said.

Mark

 

[tom in MO]

The current guidance is that warfarin does not need to be stopped for colonoscopies. Only if the colonoscopy will include some type of procedure (e.g. polyp removal.) So if it's just the routine diagnostic that everyone over 50 must do every 10 years, you don't need to stop your warfarin.

 

[Protimenow]

I premedicate (Amoxicillin 2 grams, 1 hour before seeing the dentist) for dental procedures, but don't make any changes to my warfarin dosing. My dentist (who also teaches post-graduate dentistry at a local university) says that they're not entirely sure of the benefit of pre-medicating, and didn't encourage going off warfarin before most procedures. He said that it's not a bad idea to take the antibiotic, but so far, I haven't had to do anything with my warfarin dosing for a root canal and other procedures. (Dental implants or extractions may be another issue).

I realize that the mouth is about as far as you can get from the access point for a colonoscopy, but I thought I would mention what is apparently current thinking about anticoagulation management for some dental procedures.

 

[MarkU]

The current guidance is that warfarin does not need to be stopped for colonoscopies. Only if the colonoscopy will include some type of procedure (e.g. polyp removal.) So if it's just the routine diagnostic that everyone over 50 must do every 10 years, you don't need to stop your warfarin.

The problem is that the doc doesn't know what they're going to find until they get in there. I much prefer to do the bridge just in case so that they can go ahead and do a polypectomy if needed, rather than having to schedule a second follow-up procedure. Certainly less expensive and time-consuming that way, plus you avoid the risks associated with anesthesia another time. To me the "prep" for the colonoscopy is much more uncomfortable than the Lovenox bridge.

Mark

 

[W. Carter]

I know this thread is very old but I will have to bridge for 2 weeks for a groin hernia operation coming up on 8/28/2015. I have taken the heperin shots numerous times in the hospital administered by nurses. I have 2 boxes of 135 mg enoxaparin syringes ready to go. Actually its not too bad, i've seen diabetics do it day after day in their stomachs and it doesn't bother them.