Coumadin & having a colonoscopy

[Loretta]

I haven't been on for a long time. I was wondering if any one here has had a colonoscopy while they are on Coumadin? I never had one I am 73 yrs old & have A fib (24/7), St. Jude valve ( 9 th yr. anniversary) copd, & pulmonary hypertension. I am going for a Barium enema tomorrow because I am too afraid of going off coumadin or staying on it while they do it.
What kind of experience has any one have? Thank you Loretta

 

[tom in MO]

My colorectal guy said that coumadin is not a problem for just a colonoscopy. However, it is a problem if they are going to do something more than a colonoscopy, such as remove a polyp. I don't remember exactly what he said in this situation, but I believe it was to stop coumadin for awhile and maybe use a different anticoagulant. Someone else here should be able to give more accurate information.

 

[RobThatsMe]

Hi Loretta,

When I had the procedure, I had to come off the Coumadin, and then bridge with Heparin. I had no issues other than having to give myself a shot in the stomach twice a day for a week.

Rob

 

[Cooker]

I came off for four days dropping to 1.3 ... no problem ... my gastro and cardio said no to having it done while on warfarin....

 

[catwoman]

I stayed on warfarin for my last colonoscopy. The GI doctor did want me to come off warfarin. I told him if I was taking it for a-fib, I would do so, but with a mechanical valve in the mitral position, I would not.
So we compromised. I got my INR down to 2.5, per his instructions.
It was not difficult to do -- and I was surprised that it was 2.5 on the nose that morning. And wouldn't you know -- no one asked me about my INR when I reported in for the procedure!!!!!!!
I believe one or two people have been on warfarin for c-scopes and even had small polyps removed.
I'll have to have one again in December 2013. I will again insist on having it done while fully anticoagulated. A former member here -- not sure if he has popped in for quite some time -- lost his dad due to a stroke the day his dad had a colonoscopy. The dad had a mechanical valve (mitral) and went off his warfarin for the procedure. That afternoon, son goes to check on him and he had had a massive stroke. I think he was in his 60s. Was put in a nursing home, died about 12 months later. Doctors were all pointing fingers at each other, and son determined that the doctor who was supervising his dad's ACT didn't have a handle on it. Very sad.
It's one of those "it won't happen to you" situations. Except it did happen to someone. I want to avoid being that "someone."

 

[lance]

Marsha,
Was the poster WarrenR? Do you recall whether or not his father was bridged? That was such a sad story.

 

[tom in MO]

The current guidance from the 2011 Antithrombotic Therapy Supplement Tenth Edition (IIRC it came from the anticoag forum) states that for colonscopy w/o biopsy warafarin/coumadin can be continued w/o interruption. This was not the case in the past.

 

[Duffey]

I came off for four days dropping to 1.3 ... no problem ... my gastro and cardio said no to having it done while on warfarin....

I want to mention that Tom's mechanical is in the aortic position rather than the mitral that you have which might explain why his level could be dropped lower.

 

[MarkU]

I've had four colonscopies in the past ten years to remove pre-cancerous polyps. Each time I've done a Lovenox bridge, where you stop your Coumadin three days before and give yourself Lovenox injections every 12 hours while you're off the Coumadin. Not a big deal. I was a little apprehensive the first time I had to give myself a shot but it quickly became routine.
Mark

 

[AgilityDog]

I have 2 mech valves. I'm not coming off or bridging for anything less than serious work!
My first and only colonoscopy was done with INR at 3.5.
Gastro said if he found a polyp we'd have to do another, with a lovenox bridge b/c he was not comfortable taking a sample with me anticoagulated, but with no symptoms and no reason so suspect any issue, the colonoscopy itself anticoagulated was fine.
Of course I had to find a Gastro who would DO IT this way via my Cardio.
The entire Gastro staff treated me as "very special." No one could believe, looking at me, that I've had as much cardiac work done as I have.

 

[catwoman]

Marsha,
Was the poster WarrenR? Do you recall whether or not his father was bridged? That was such a sad story.

Yes, that was WarrenR.
To the best of my knowledge, he was ot bridged.

I have never bridged. LMWH can cause bleeding issues, so I have not decided what I will do when I am faced with that decision -- whether to go off warfarin completely (and face a clot or stroke); to bridge with Lovenox or a similar RX (and face bleeding issues); or go in the hospital to go off warfarin and then go on a heparin drip.

 

[Loretta]

Yes, that was WarrenR.
To the best of my knowledge, he was ot bridged.

I have never bridged. LMWH can cause bleeding issues, so I have not decided what I will do when I am faced with that decision -- whether to go off warfarin completely (and face a clot or stroke); to bridge with Lovenox or a similar RX (and face bleeding issues); or go in the hospital to go off warfarin and then go on a heparin drip.

Hi, can yu tell me what LMWH means also are yu saying Lovenox or Heparin drip can also cause bleeding? I'm so in the dark about all this. I did finally go for the Barium at the hospital & not go off my coumadin. The test was fine didn't show any polyps,or blockage. Gastro dr. seems satisfied with results & so am I. I'm 73,in AF 24/7 -mechanical valve (mitral) since Des.2003, Copd emphersema, & with a recent Echo found out I now have pulmonary hypertension. So I do have health issues that worry me. loretta

 

[Protimenow]

LMWH=Low Molecular Weight Heparin = Lovenox (or generics).

And, yes, Heparin and Lovenox can - and sometimes do - cause bleeding issues. That's why anyone who has used Lovenox can report significant bruising around the injection site.

Getting the Barium Enema sounds like it was a good clinical decision, and avoided the problems associated with colonoscopy. (On the other hand, if the BE detected polyps or other things, the colonoscopy would most likely have been performed for further diagnosis and treatment).

 

[RobThatsMe]

LMWH=Low Molecular Weight Heparin = Lovenox (or generics).

And, yes, Heparin and Lovenox can - and sometimes do - cause bleeding issues. That's why anyone who has used Lovenox can report significant bruising around the injection site.

Getting the Barium Enema sounds like it was a good clinical decision, and avoided the problems associated with colonoscopy. (On the other hand, if the BE detected polyps or other things, the colonoscopy would most likely have been performed for further diagnosis and treatment).

I believe that they, the doctor / pharmacist, also adjust the amount of Heparin dose prescribed based upon your body weight.
Each injection needle should only contain the amount of Heparin based upon their weight dosing chart recommendation.
Usually when you pick up your Heparin prescription, they are already adjusted for the correct dose. However, in some cases, I think it is up to the individual to make that adjustment.

Anyone else have input on this?

 

[MarkU]

I believe that they, the doctor / pharmacist, also adjust the amount of Heparin dose prescribed based upon your body weight.
Each injection needle should only contain the amount of Heparin based upon their weight dosing chart recommendation.
Usually when you pick up your Heparin prescription, they are already adjusted for the correct dose. However, in some cases, I think it is up to the individual to make that adjustment.

Anyone else have input on this?

Just based on my personal experience, but I have found that the bruising around my injection sites has been greatly reduced as I've gotten better at giving myself the shots. I've been through four Lovenox bridges now and the first time was definitely the worst for bruising.
Mark

 

[Protimenow]

Lovenox dosing is definitely based on body weight. When the prescription is written, you doctor (who should already know your body weight) indicates the dose, based on weight. This makes it a lot easier than trying to figure out how to spill out part of a syringe of the stuff in order to adjust it to your specific weight. That said, the weight is an approximate weight - not exact weight - so that the dosage is offered within weight ranges.