Continuing warfarin through wrist surgery

[DebbyA]

A totally unscientific report that may be useful. Two weeks ago I fell and broke my right wrist badly enough that it required surgery. I was worried about bridging because of a near-disaster after mastectomy several years ago. The surgeon said he did not stop warfarin for this surgery because of the impact on the patient : "i can deal with blood". Surgery went well.

 

[pellicle]

Indeed Debby, that is apparently the new norm with pressure systems (something like stiff inflatable casts) around the upper part of the limb excluding blood from the lower part. My surgeon in this operation:

http://cjeastwd.blogspot.com/2020/10/another-example-small-procedure.html
said similarly and thus I made less concerted effort to control my INR down. My INR remained mid 2's

it seems to me that with each passing year the combination of:

• better surgical methods
• access to self testing and better understandings of INR management (certainly not by the labs, but by patients)

contribute to the diminishing of the historically given obstacles to AntiCoagulation Therapy being a reason to pick a valve which will no doubt fail in time in a younger patient.

Sorry to hear about the break, I hope physiotherapy is helping restore range of movement.

Best Wishes

 

[Warrick]

I had my sternum wires removed 11 months after my AVR, my INR was 2.1 so in my range of 2-3. Two incisions, didnt need a blood tranfusion lol
Last year I had a nurse at first refuse to give me a flu vaccine because i’m on warfarin, I set her straight when I rattled off my INR result from a few days prior. I haven’t bled out from any needle sticks yet

 

[pellicle]

I haven’t bled out from any needle sticks yet

geeze mate ... where's the ANZAC spirit ...

 

[carolinemc]

I had my sternum wires removed 11 months after my AVR, my INR was 2.1 so in my range of 2-3. Two incisions, didnt need a blood tranfusion lol
Last year I had a nurse at first refuse to give me a flu vaccine because i’m on warfarin, I set her straight when I rattled off my INR result from a few days prior. I haven’t bled out from any needle sticks yet

Good for you, for we are autoimmune compromised and need the flu shot. I have been getting that for years now. And I have gotten some bleeding from needle stick from INR/Pro time. Didn't die from them yet.

 

[Chuck C]

Last year I had a nurse at first refuse to give me a flu vaccine because i’m on warfarin,

The level of warfarin illiteracy in the medical field is very disappointing. A nurse should know better.

 

[pellicle]

The level of warfarin illiteracy in the medical field is very disappointing.

But consistently common, just like the impressions in the general public...

 

[Chuck C]

But consistently common, just like the impressions in the general public...

Not surprising when you have Edward’s Lifesciences shamelessly stating misleading comments about warfarin, facilitating the current myths.

https://www.edwards.com/devices/heart-valves/inspiris-resilia
Their claims:

• Freedom to live a more active lifestyle
• Fewer dietary restrictions
• No need for long-term anticoagulants
• No clicking sound with every heartbeat"

The reality:

Despite the misleading comment, you can live an active lifestyle on warfarin- I do.

Despite the misleading comment, you can eat your greens and, other than not eating grapefruit, have almost no dietary restrictions. Most taking warfarin for years will tell you that they eat what they want. I eat whatever I want- and don't mind skipping the grapefruit as I don't care for it anyway.

Despite the misleading comment attempting to amplify the fear over the clicking sound, the vast majority of mechanical valve patients are not bothered by the sound. It has been estimated that less than 2% are bothered by it. I certainly don't hear mine "with every heartbeat", as their fear mongering suggests- in fact, I hear it less than 1% of the time and when I do hear it it never bothers me.

What is odd, is that they would rather use misleading fear mongering, rather than discuss what is one of the biggest actual benefits of a tissue valve. When those with a tissue valve face other surgeries, provided that they are not on anti-coagulation for some other reason, no worries about increased risk of bleeds or clots from holding warfarin or the bridging process. Not any mention of this.

When myths and fear mongering are good for business, it is interesting how not much is done to educate folks.

 

[pellicle]

What is odd, is that they would rather use misleading fear mongering,

because nothing motivates as well as fear

https://www.psychologytoday.com/au/blog/the-main-ingredient/200909/the-most-powerful-motivator

 

[slipkid]

because nothing motivates as well as fear

https://www.psychologytoday.com/au/blog/the-main-ingredient/200909/the-most-powerful-motivator

The same strategy used multiple times in recent years in this country for political gain. Blind the people as to the real issues and what you really "stand for". Play on their fears (and prejudices). Win at all costs. Etc.

 

[pellicle]

Win at all costs. Etc.

Yep, but if anyone is interested...