Coumadin and colonoscopy

[catwoman]

My cardiologist's RN has told me I will have to be off Coumadin for 5 days B4 my next colonoscopy, then go back on Coumadin the day of the procedure.
Have not called the gastroenterologist to set up an appt yet.
Is this the usual procedure, going off for 5 days? Is there not a protocol to just reduce the dosage?

Have not checked with insurance about having a virtual colonoscopy.
Had a colonoscopy in July 2001, and 2 small polyps were found. My mother and grandmother had colon cancer. My PCP wants me to have the test every 3 years.
If I had a virtual colonoscopy and a polyp was found, I'd have to prep all over again for a 2nd procedure, go off Coumadin for 5 days and pay co-pay for both procedures.

Also, anyone know of stats on people who **have** had clots immediately after having a colonoscopy?

 

[Ross]

http://www.warfarinfo.com/bridgetherapy.htm

They should be placing you on bridge therapy if they intend to discontinue Coumadin. Consult all your Doctors for their opinions. Why these guys keep insisting on risks is beyond me.

 

[tommy]

Marsha,

I have used the Lovenox bridge therapy twice. Once for a root canal and once for hernia surgery.

My protocol was similar to the one on the website (Ross's post), except that I dropped Coumadin a day or so earlier, and did not start the Lovenox until my INR got below range (2.4). I home test.

Keep in mind that Lovenox does not show up in the INR test. So when your INR is close to being in-range, you are essentially double covered - not totally a good thing. My hernia incision oozed for about a week, longer internally.

Don't know specifically what to expect from polyp removal - maybe others will post.

Lovenox is expensive and comes in packages of ten shots. My local Walgreens had to order it. Forget that. If you need more than ten shots (five days), you'll want to wait as long as possible to see if you need more, and if you do, you'll need it right away. Our Target pharmacy stocks the stuff and was very responsive.

Hope this helps.

 

[Guest]

There really is no data about going off warfarin for the colonoscopy. Who would want to be in the see how long they can go group?

So you just have to go with what the doctor recommends. One of my patients had a stroke before they could get her INR back up. I have also seen one that included a polyp removal that had no bleeding when she was in the 2 - 3 range. I did not talk to the gastroenterologist about it but I confirmed with the lady that she had taken her warfarin that morning. She lives about 90 miles from the hospital and came in with severe cramping and they did the colonoscopy stat. The next day her INR was also in range, so I know that they did not give her anything to lower it. I didn't have a change to talk with gastroenterologist but I did talk with her primary. He said, "Yeah, kind of surprising isn't it? I couldn't believe it either." He had asked the same questions that I did.

With your risk factors, it seems that you need the colonoscopy, so I would try to talk them into bridge therapy. Some doctors are resistent, it requires more work but it is your valve that will have to be replaced if you are one of the unlucky few.

 

[catwoman]

Tom:

Talked with my niece, a nursing student at Brookhaven in Dallas area. She's been a paramedic/firefighter and has worked at a medical clinic. She suggested I look into Lovenox.

Al:

Thanks for your comments. Is there any research on reducing dosage of warfarin before GI tests, particularly a colonoscopy?

 

[Lisa in Katy]

From what I understand, the colonoscopy itself and even a minor biopsy don't have a high risk of bleeding, so some doctors don't take patients off Coumadin for these procudures. However, polyp removal does present a higher risk for bleeding. Since that might be a possibility in your case, it is probably why they are saying they want to take you off the Coumadin. I would insist on bridge therapy, which is what I did for my hysterectomy. Your Gastro needs to consult with your Cardio, and I'm sure that bridge therapy is what he would recommend.

 

[Guest]

There is no research - who would volunteer for the see how long they can got before they wreck their valve or stroke out group?

 

[catwoman]

Al:

Don't mean a research group set up as a test with controls, but results from cases of strokes in patients who had to go off warfarin before medical procedures.
Has anyone compiled such results?

 

[Guest]

The reason I was trying to be funny is that there is no data.

We know it happens, but no clinic would see enough instances to draw any solid conclusions.

 

[cookie]

I there!
I just had a colonoscopy a month ago and insisted that I be on some kind of bridge therapy. I took Lovenox injestions for approximately 2 weeks - a week prior and a week after. I did have to have a polyp removed as it turns out so was thankful I did the shots, but I ended up getting the flu a week after the test with running to the bathroom and hanging over a bucket. The bathroom shifts were so violent that it caused the scab on the polyp removal to break loose and I ended up in the hospital being given 5 bags of fresh frozen plasma to stop the bleeding so the wound could be cauterized again. What a mess!
I still would not do this test without any kind of bridge therapy. Chances are, if you have already had polyps removed, there will be more. It is an agonizing decision and I postponed the test 3 times before just biting the bullet and doing it. My return to the hospital was just a combo of bad circumstances that came together at once. The shots are not nice but you can live with it for the peace of mind.

 

[Marty]

Bridge Therapy

Bridge Therapy

Marsha I checked with one of my very busy gastroenterologists at Falls Church KP. They would not do you without stopping warfarin and bridging with Lovenox. They do the prescribing themselves with help from the pharmacists who like Al run our anticoagulation service.

 

[catwoman]

Cookie:

Thanks for telling me -- and others -- about your experience. You probably would have been just fine had you not gone through a nasty bout with the flu.

Marty:

Thanks for the info about the gastroenterologists there. I'll start checking with the Dr. who did my last one and see what he says.