Continuity pre. vs. post-op

[bvdr]

I just have a question for those of you who were on coumadin pre-operatively as well as post-operatively.

This is the background. I started coumadin a few weeks ago at a dose of 4mg. My first INR was 1.7, the next one was 2.8, and the one today was 5.0. I wasn't scheduled to have another until next week but will be out of town and thought I'd get one early so I wouldn't have to think about it when I was gone. I have really tried to keep everything very consistent so I could get a good feel for how my body would take to coumadin. Today, as a result of the INR of 5.0, my PCP lowered my dose to 2.5 and I am to retest in two weeks which I believe is the date I'm suppossed to take my last dose prior to surgery. He says this will help us get a better handle on dosage for after surgery.

Knowing that I may be on different medications post-op I am wondering if it is worth bothering with another INR. Did any of you run into anything similar and/or was your dose after surgery very close to before surgery?

I know this seems to be a minor thing but today I spent about 4 hours at my PCP's office and then about an hour waiting to get my new prescriptions filled at the pharmacy.

 

[Ross]

How soon before surgery are you supposed to stop taking it? If it's only a day or two, I wouldn't bother. In fact, I wouldn't bother anyway because they should do one the day of surgery to make sure they aren't going to have problems. I think it's a non issue until after surgery. That's my opinion anyway.

 

[fyrfytr]

Hey Betty,
Speedo Ross beat me to it. I was going to tell you same thing. Why worry about it. Take Care
Dave


___________________________________
Surgery: 4/21/03
Aortic Aneurysm Repair
AVR, with a St. Jude Mechanical

 

[Nancy]

Prior to surgery, in just about all cases, Joe had frequent Protime tests.

At least in his case, they wanted to have a stable situation near surgery. Then a couple of days prior, he had daily testing, and also had one the morning of surgery.

After surgery, there are at least daily protimes, maybe even more than once a day. There's a whole protocol for after surgery. Anticoagulation isn't given until the initial bleeding stops. then is introduced very gradually along with heparin drips. It's test, test, test.

At least that's what I remember.

 

[Ross]

I just don't see the reasoning behind testing like that before surgery. So many things happen that even if something stable is achieved before surgery, it may not be the same afterwards and the process starts all over. I'd say ask your Doctor. You'll be getting poked enough before and after.

 

[bvdr]

Ross, I checked my calander and my next INR is scheduled for the 20th, I'm suppossed to take my last coumadin that night and I get admitted on the 24th to start heparin prior to surgery the 25th. I'm glad I had it checked today because if it was still heading higher I may have had a problem on our trip next week.

I appreciate your input since this sure seems like spinning wheels to me.

Enough about me....how are you all doing

 

[Ross]

For safety sake, check with your doctor none the less.

I'm hanging in there. Same old same old here, nothing new.

 

[ccrawford]

Dave beat me to it. Ross's new name is Speedo the Troll !

 

[LUVMyBirman]

Geeze Betty. What a wait! See if you can find a Coumadun clinic. Or at best, when your cardioligist office has lab. Usually they schedule this between certain hours so you don't have to wait all day!

From personal experience, 4-1/2 years of it. I feel he dropped your dose too far. Your next INR may be low. There is something to be said about the 10% rule. Iincrease or decrese depending upon results. It usually works.

If you have time....go back in 3-4 days and retest. They can also give you an order to draw your INR while away. Any hospital outpatient lab will take care of this for you. Before my home testing days I used this method when traveling. If you find the location they can also just fax the order over.

Have a nice trip and keep us posted.