Colonoscopy & Coumadin Issues

[njean]

I have been told by my cardio that should I want to have a colonoscopy done, I would probably have to be admitted into the hospital & have it performed there due to the present state of my heart & the instability of my INR. My Internal Medicine doctor says that they would just stop my Coumadin for 2-days prior to the procedure & then start me on Lovonox injections right after, start me on coumadin until I'm therapeutic. Frankly, I'm plain scared to have one done because of everything but after going with my husband to have his done yesterday, & the doctor finding 6 polyps, I know I need to have one scheduled soon.

Every now & then, I notice some blood after a bowel movement but I have been writing it off to hemoroids since I suffer from them too.

Has anyone else out there had some big issues with this procedure & what would you recommend??

 

[Ross]

No issues and I had it done fully anticoagulated. Two polyps removed also with no bleeding afterwards.

 

[catwoman]

Norma:

You need to read up about Warrenr's dad, who had a mechanical mitral valve and had a colonoscopy. Long story short: He suffered a stroke the day of the procedure and spent the rest of his life in a nursing home.

My GI doc, cardio & PCP have all said I will be anticoagulated (at 2.5) for a colonoscopy. And, yes, I have had polyps removed before (this was pre-MVR).

 

[ALCapshaw2]

Norma:

You need to read up about Warrenr's dad, who had a mechanical mitral valve and had a colonoscopy. Long story short: He suffered a stroke the day of the procedure and spent the rest of his life in a nursing home.

My GI doc, cardio & PCP have all said I will be anticoagulated (at 2.5) for a colonoscopy. And, yes, I have had polyps removed before (this was pre-MVR).

Norma,

You also need to know "The REST of the Story" about WarrenR's Dad. His Doc had MIS-managed his Coumadin for a LONG TIME before the procedure (INR was Too Low) and took him OFF Coumadin (with NO Bridging) as I recall so this is NOT a typical situation and probably NOT applicable to YOUR situation.

That said, I have found there seem to be about as many philosophies about Bridging as there are Doctors (OK that's probably an exageration but you get the idea).

Probably the Safest approach is to STOP Coumadin, measure INR 1 or 2 days later, and START Lovenox when the INR is down to 2.0 (or your bottom target number), then STOP Lovenox 24 hours before the procedure.

Assuming there is NO significant Bleeding Risk following the procedure, RESUME Lovenox the night of the procedure (i.e. ~8 hours after the procedure) and RESUME Coumadin that same night at your Normal Dose. When your INR is Back In Range, discontinue the Lovenox.

SOME Doc's simply have you Stop your Coumadin and Start Lovenox 24 hours later which is not a bad approach and saves having to do extra tests.

IF the GI Doc is concerned about Bleeding Risk, he may want to simply Start Coumadin that night, following the procedure, and start Lovenox 24 hours later, until your INR is in range. Note that the effects of Lovenox are generally considered to be 'mostly' dissipated after 12 hours so you usually take 2 injections per day. Dose is base on Body Weight.

As you can see, there is a Lot Wiggle Room in Bridging as the Doc's try to Balance the Risk of Stroke vs. the Risk of Bleeding. (Been There, Done That, Twice)

SOME GI Doc's are willing to do an Exploratory Colonoscopy while fully anti-coagulated and I believe this philosophy has been endorsed by the Medical Society for GastroEnterologists. I expect Most will want you OFF anti-coagulation if they are going to remove Polyps (although Ross's Doc made an exception).

'AL Capshaw'

 

[Blanche]

Al Capshaw:
I agree with your assessments to a point. However, somehow the gastroenterologists in our part of the world have become enlightened of late. Albert's last two colonoscopies and one endoscopy were done while fully anticoagulated. My last colonoscopy was done fully anticoagulated and two polyps were removed.

I thought this was interesting and asked around. It seems that doing colonoscopies and endoscopies without disrupting anticoagulation is not an exception to the rule. Without extending circumstances, it is the rule here in the Phoenix, Arizona area.

Recently we had the opportunity to visit the Mayo Clinic in Socttsdale Arizona. I am told that they do colonoscopies, as a rule, while patients are anticoagulated, unless other circumstances pervail.

Kindest regards,
Blanche

 

[njean]

Thank you all for your input. I really appreciate it!

I was just talking to my husband & he reminded me that last year in June/07 when we flew to Houston because the doctors were sure that they were going to have to do the 4th OHS due to the malfunctioning mechanical mitral valve, I was told to stop my coumadin 2 days prior to flying to Houston. We flew out on a Saturday & I didn't meet w/Dr. Cooley untl Monday, still without coumadin. Once I was admitted I was started on hephrin & kept in the hospital for 2 weeks for observation.

Then too, 3 years ago, I had to have a molar extracted & my coumadin was stopped for 1-day prior to the procedure & then I did two injections of Lovonox & all went well then too. Honestly, I think I'm just looking for an excuse not to have the colonscopy done! I'm just chicken!

 

[briansmom]

My son had to have his colonoscopy right after his first OHS, he was fully anti coagulated, in fact his INR was high at the time (5.0). They said that they would not be able to remove any polyps (but that was not his problem anyway) with an INR that high, but they weren't worried about doing the procedure.