Coumadin Question

[Unregistered]

Hello everyone - My question is mainly for Al but would like anyone to answer if they can - Had Mitral Valve Replacement surgery (tissue) November 21 2005, on Coumadin 7.5 MTWS and 10.0 on Thu/Sun.

I have to have a Stereotactic Breast Biopsy on March 28th, the person who scheduled me said "You must come off ALL coumadin and any aspirin therapy starting March 18th"

I called my Cardio PA who said "You are only taking coumadin for your A-fib (which is chronic but I also had my Left atrial Appendix removed during the OHS) so go off the coumadin but stay on the aspirin because I'm on the low dose of 81mg". She also stated no big deal to be off coumadin for 10 days.

From what I understood from the biopsy person the cut they do is only a quarter size wide Why must I go off the coumadin This scares me more than the OHS. The rate my health is going lately I am sure to be one of those "oh she threw a blood clot and had a stroke poor thing" and having to deal with OHS and recovery and Now maybe breast cancer to deal with in a very short time is really just too much at this time. Thank you all in advance!

Tiffin - Anchorage Alaska

 

[Ross]

Hi Tiffin, why not sign up and come inside? Doesnt cost you a penny and you've already had the surgery, so you know what it's about.

Al seldom looks down here, so I'll PM him the link to your question. Being tissue, it's probably not a terribly big issue for you to come off the coumadin for that long. It would be a real no no if it were a mechanical valve. I'm not the expert here, so I maybe talking stupid too. Anyhow, welcome and think about joining and coming inside.

 

[PJmomrunner]

Hi Tiffin!

You do sound like your plate is full enough without worrying about being the "Oh-she-threw-a-clot" lady too! A quick google of "stereotactic breast biopsy coumadin" reveals guidelines that typically recommend coming off coumadin and other "blood thinners" for three days before and one only mentioned for three days after. One website said to talk to your doctor (cardio, I presume) about what to do--I would do that if I were you. Ten days is a lot different than three!

 

[Guest]

I'd negotiate with the doctor doing the biopsy. Get your INR checked about a week before the bx. Then agree to hold your warfarin for one day for every two units that you need to come down. Example if the INR is 4 the hold for 2 days to get to 1. You take a fairly high dose so your INR will drop fast. Then get another INR right (2 hrs or so) before the bx. Your risk of having a stroke is low but it is present. I don't understand about the aspirin. If you don't have clogged arteries, the aspirin only increases the chance of bleeding and does not lower the risk of stroke. Aspirin is not recommended for stroke prevention in atrial fibrillation. The dose of aspirin makes very little difference. Actually it takes about a week to reverse the effects of aspirin but only two days to reverse warfarin. However, since aspirin is non-prescription, it seems to be assumed that it is less bothersome than warfarin. But the recommendations are quite often reversed.

I had a melanoma on the top of my head. I take aspirin 325 mg daily. I asked my doctor about it in the hall of the hospital and he said that he would cut it off in an hour. Obviously I did not have time to hold aspirin. The melanoma tested positive, so the recommendation was to have another area scooped out around it to be sure that they had gotten it all. This time I made an appointment with a dermatologist. I held my aspirin from Sunday until Thursday. Throughout the procedure he commented that I was losing a lot of blood due to not holding aspirin long enough. I looked at the pillow case and it looked about the same as the previous cutting. Then I asked the first doc if he thought I bled more than usual when he did the original procedure. He said - about what I would have expected. So bleeding (like beauty) seems to be in the eye of the beholder.

Doctors fear bleeding, patients fear clots.

 

[ArleneT]

Hi Tiffen,

Can't help you at all with the coumadin question, but I had surgery, chemo and radiation for breast cancer in 2005 and just had a mitral valve repair on 2/6 of this year. So, I know a little bit about how you are feeling right now. It's a lot to handle in a short time.

I have some very good resources for any breast cancer questions you might have including an excellent forum. Just let me know if you'd like any of this information.

Best wishes,
Arlene

 

[Guest]

Don't forget that something like 75% of breast biopsies are negative.

 

[geebee]

I had a biopsy and a lumpectomy both while on coumadin, although I made sure I was on the low end of my range. I have had way too many TIAs to come off coumadin for anything. Not saying you should not come off but wanted to let you know it is possible to do this while on coumadin.

 

[ALCapshaw2]

It sounds like the Dr. doing your biopsy is being overly conservative.

There IS another alternative, namely Bridging Therapy, using Lovenox Injections in place of your Coumadin for several days prior to your procedure. Lovenox is short acting and can be taken up to the day before the procedure and then resumed (usually) the night after the procedure, along with a 'loading' dose of Coumadin for a day or two until your INR comes back into range at which time you discontinue the Lovenox. Discuss this option with your CARDIOLOGIST who should manage the Lovenox procedure. Also check with your insurance carrier to see if Bridging Therapy with Lovenox Injections is a covered benefit. Each injections costs around $100 so insurance coverage is a BIG issue!

Hope all goes well for you.

'AL Capshaw'

 

[twinmaker]

Hey Tiffen, I had a lumpectomy several years ago (the mammogram found microcalcifications) and I was on Coumadin (mechanical mitral valve). Normally they would have done a biopsy while I was lying face down on a table. Is this the type of procedure you're talking about? The radiologist was not comfortable doing this type of biopsy with someone like me so I had to see a surgeon. Anyway, my hematologist at Johns Hopkins wanted me off the Coumadin and placed on Heparin IV for the lumpectomy. Needless to say, I spent 8 days in the hospital waiting for my INR to come back up to range. (I'm one person who's had some bad experiences with Lovenox...most people don't). Anyway, my biopsy was negative. I will keep you in my thoughts and prayers as you go through this. I know how hard the waiting is for something like this. Please consider joining our group here. Everyone is really helpful and we're really like one big family! LINDA

 

[Unregistered]

from Tiffin

from Tiffin

Thank you all for answering so soon about my coumadin problem! I've sent Ross an email about me joining here. As I said my biggest fear is throwing a clot since A-fib is major cause of that but I guess that worry shouldn't be since the Left Atrial Appendix is removed right?

Al thank you for all your suggestions I will call on Monday to Cardio doctor and the doctor who will be doing the biopsy, I agree why take aspirin its not going to help with anything really. I'm on the high doses of coumadin due to the fact I love my greens lol we are pretty much veggie eaters and All the ones I love are the ones high in Vit K <G> and its only been this last 4 weeks that I got staple with my level it had been bouncing all over the place.

And special thanks to the women here who reached out and shared that they too have had to deal with biopsies.

Yes the Stereotactic Biopsy is the one you lay on table on your tummy so they can draw the samples.

As soon as I hear from Ross I'll be posting more and hopefully all this fear is for nothing!