coumadin and surgery

[cookie]

Can anyone help? I had aortic valve replacement and an aortic graft 6/6/2000 and am doing really well. The thing that really bothers me is I have really bad bunions that are now starting to bother me and my only option is surgery. I also did "something" to my knee and I can't stoop down anymore without real pain. Doc is talking about scoping the knee! I have heard that ortho surgery is known for blood clots and that scares me. How is the coumadin handled in situations like this? My doc wanted me to take Vioxx for the pain but that scares me even worse!
I got all this news the same day my daughter informed me I'm to be a Grandma for the first time! Finding out I'm probably arthritic and going to be a Grandma all in the same day really made me feel old!

 

[LUVMyBirman]

All good questions Cookie. I have and arthritic knee and one bunion. They flare occasionally. It is very common for the women on my family to have both of these surgically taken care of. I am young enough not to have to worry about it now...but the thought has crossed my mind.

They will defiantly have you on the Heparin after surgery. You will also take these injections home with you. Lovenox is the brand most commonly used. It probably will not be too much different from your valve replacement in regard to how they handle it. They may have to keep you in a higher therapeutic range temporally after the knee replacement, not sure.

As for the Vioxx. Be very careful. It has been know to cause bleeding in the average patient not taking Coumadin.

Keep us posted

 

[Nancy]

Hi Cookie-

If you're on Coumadin be wary of Vioxx, also if you're on Lasix be extra wary. My husband was put on Vioxx and blew up like a balloon from fluid retention, 10 pounds in a week. He may have different conditions than you do, but it can blunt the effect of diuretics and interferes with Coumadin. He's been off it for 2 days and is starting to show some improvement, but Vioxx or Celebrex is NOT for him!

Check with your doctor and also do your own search on line. Maybe you'd be OK with it. Just be cautious.

 

[strayze]

I had my knee injury "scoped" (arthroscopy). I stayed on the Coumadin. My INR was 3.3 during and immediately after the surgery. Nonetheless, immediately after surgery I developed thrombosis in the calf below the surgical knee and a lung embolism. About a year afterward, after asking lots of questions of my surgeon, my internist, etc., and after being abandoned after another surgery (where I went off Coumadin) by primary care provider for being "too complicated" and refusal to measure post surgery INR,- - after all of this- - the breast clinic at Hopkins advised that I needed to get off raloxifene (Evista) immediately forever, with my clotting problems. (I was still on 6 mo waiting list at that time for a primary care physician after the abandonment without reference. The previous hd put me on it and then abandoned me and would not answer the clotting questions.)

I don't want to make this too long, but arthroscopy can be done while on Coumadin as a tourniquet is used during the surgery. However my experience was that this did not prevent the post surgical clotting and pulmonary embolism problem. As I reconstruct this, it would have been worse without the Coumadin. I should definitely have been advised both by the primary and the surgeon to go off the raloxifene. The bed rest with raised leg and the immobility undoubtedly contributed as well as the raloxifene.

Since this experience and others I no longer get any care at all locally in Annapolis, taking it instead to Hopkins.

 

[Gisele]

Hi Cookie~~~~I've had surgery multiple times since my mitral valve replacement. They have replaced going in days ahead to receive a heparin drip to self injections of Lovenox. What your MD can opt for if this is for you, is to discontinue your Coumadin 4 days prior to surgery, and start you on Lovenox injections twice daily. The pills take days to leave your system, but the injections are quick to boost and to exit. That way you are left for a minimal time with less or no anticoagulants. It depends on your cardiologist, but for a valve replacement, I would think that your MD would want you "unprotected" for as minimal time as possible. Post surgery you resume your pills and your injections. The Lovenox is discontinued when your INR has reached an acceptable level. Good luck.............Gisele

 

[cookie]

coumadin & surgery

coumadin & surgery

Thanks to everyone that answered my question. I still don't like the idea of any surgery or going back into the hospital! I may just live with the pain! After open heart surgery and 2 return trips to the hospital for complications I am in no hurry to see that place again!

 

[martha]

Hi Cookie,

I have arthritis and take vioxx with no problems. Be sure to take it with food or milk though. As far as bunions I can't say that has ever been a problem. Congratulations on becoming a grandmother. Do they live near you so that you will be able to enjoy the new little angle? martha

 

[Nancy]

Re: Vioxx

Re: Vioxx

Thought I would mention Vioxx again for those of you who are on Coumadin and diuretics, it interferes with both.

Joe was on Vioxx for only a week, gained 10 pounds and is now taking 80mg Lasix twice a day to get rid of the fluid, also his INR today was 4.7. So now he has to have extra bloodwork in a week to check his kidney function and also his INR.

This is a total PIA that we didn't need!!!

 

[Guest]

I am a pharmacist who monitors warfarin and runs the website www.warfarinfo.com If you do have surgery, the warfarin that you are taking for your valve will adequately protect you from a clot. (Not that there is no risk -- there always is but you will not have any added risk.)
By far the vast majority of people who take Vioxx or Celebrex and warfarin have no trouble. They are among the most prescribed medications in America. If even 5% of the people taking them had problems, there would be vast traffic jams caused by all of the hearses leading funeral processions.
They are not safe for everyone, but when the doctor carefully considers whether or not you are a candidate, the risks are small.