Coumadin and surgery?

nefarious_muse · Jul 29, 2003

Hello All,
My husband is having an "in-office" surgery at the end of the week and I'm a nervous wreck (yes, this is an everyday thing for me! see my other post under heart talk!)

He's having surgery on his foot (has a hammer toe and is getting a joint removed - under local anesthesia), and his surgeon instructed him to stop taking coumadin on the day of surgery.
My husband laughed and told him that if anything, he'd probably need to stop taking it a day or two before and not day of surgery! In any event, my husband then called his cardiologist, who confirmed that because he is at the lower end (INR 2.1 at last test), that it would be OK to drop down his dosage two days prior to surgery (i.e. go from 3 pills per day to 2 pills per day) - and of course to make sure that he started antibiotics 24hrs prior to surgery.

Any thoughts on this? I'm a little nervous about the fact that he will still be on Coumadin...but I guess the risk of him bleeding is not as bad as the risk of him clotting, right? Would appreciate your opinions

Nef (aka "nervous nellie")

Ross · Jul 30, 2003

Follow the Cardiologists advice. Sure he'll bleed but if need be, they can give him plasma or Vitamin K slowly to reduce the effects of the coumadin. Some day, all these dang Doctors will get it together and be on the same page when it comes to Coumadin patients. Right now, their all over the place with telling us the wrong things to do.

Being a joint surgery, I'd think bleeding would be minimal anyhow. Someone correct me if I'm wrong please.

bvdr · Jul 30, 2003

I am prone to agree about following your cardiologist's advice. I think that any surgical site where direct exterior pressure can be applied is, as far as excessive bleeding issues are concerned, safer for surgery than something internally. I would still have a back-up plan however in case the bleeding did become an issue. Is your doctor a podiatrist or an orthopedic surgeon? Sometimes podiatrists don't have hospital privileges and that limits some of their options.

JimL · Jul 30, 2003

I had two cysts removed 4-1/2 weeks ago, and I stayed on the full dosage of coumadin. It did take a while to find a surgeon who would agree to do it this way. I had full anesthesia for the surgery.

The surgeon did say that it was the coumadin's fault that they took so long to heal up, but I'm still not convinced. There was just drainage afterwards.

Nancy · Jul 30, 2003

My husband had a very small skin tumor removed in-office while on Coumadin. Everything went fine during the removal and afterwards, until the scab decided to separate early. Then he had a big bleeding incident, and went to the ER. After about an hour and a half, it finally stopped with pressure applied.

The ER doctor applied a really secure bandage and everything turned out OK. But we did have to find a surgeon to change the small dressing after a few days, because the skin doctor was on vacation. It was a lot of running around for a small procedure, rather than a tragedy.

I would make sure that the doctor applies a very secure dressing, even more than ordinary, so things don't start bleeding again after your husband goes back on Coumadin.

nefarious_muse · Aug 1, 2003

Thanks to all for your replies

Hubby had surgery today, and aside from some pain (now that novacaine is wearing off), everything seemed to go OK.

He's on antibiotics and doesn't seem to be bleeding through the dressing (so far, anyway).

Nef