Coumadin use and Lovenox prior and after colonoscopy.

[Dan Campbell]

I take coumidin on a daily basis after having my aortic valve replaced in 1998...replaced with a St. Jude mechanical valve.

In a few weeks, I will be having a colonoscopy and upper scope. I am planning on stopping coumidin use 5 days before the procedure, starting lovenox 2 days before & 2 days after the procedure, and resuming coumidin after the procedure.

Does anyone reading this had a similar situation, and have any suggestions.

Thanks for any input.

Dan Campbell

 

[Lynlw]

Hi I don't use coum but wanted to say if you do a search for colonoscopy and coumadin it will bring up a few threads about what others have done.Lyn

 

[Karlynn]

I don't know if you have issues for needing to have a colonoscopy done or whether it is a routine screening procedure.

The protocol for a screening colonoscopy is to not go off your Coumadin. But you should be able to find the "official" info in a link here if you do a search.

Ross just had a colonoscopy and had some polyps snipped and cauterized, all while on Coumadin.

I, personally, would not want to wait until day 2 prior to the procedure to start lovenox because my INR drops like a rock when I hold doses and 3 days of holding would put me at a fully coagulated level. You would need to stay on lovenox after the procedure until your INR is back in theraputic range. If it's not there after 2 days post, you should still use the lovenox until you're just about in range.

I will say that I don't know what the school of thought is when you throw in an upper scope into the procedure.

 

[Ross]

Yeap, I just had one done fully anticoagulated. The initial plan was to go for a look see and if something was found, admit me to the hospital for a heparin drip and another scope, but the Doc decided to snip the polyp he found anyhow. No bleeding whatsoever afterwards. The potential is there, so if you feel more comfortable going with a bridge therapy, then perhaps you'll want to do that, but it can be done while your on Coumadin.

 

[ALCapshaw2]

Welcome Dan,

I underwent a Colonoscopy and Upper Endoscopy last year. My (long time) Gastroenterologist refused to do the procedure while still coagulated. He was OK with Bridging Therapy which was managed by the CRNP at my Coumadin Clinic. Here is a brief outline of the protocol as I replied to a previous member who inquired about bridging for a non-heart related surgery:

(Note: I used method 1. I thought I had posted the exact schedule, including a 'loading dose' of Coumadin after the procedure, but I've not located that post yet - AL Capshaw)

There are TWO primary alternatives to Bridging Therapy

BOTH require going OFF Coumadin 3 to 5 days prior to the procedure / surgery.

1 - Begin Lovenox Injections to the abdo

men 1 day after stopping Coumadin and continue until 24 hours before the procedure.

Restart the Lovenox injections AND Coumadin the evening after the procedure (12 hours) OR as soon as the risk of bleeding is deemed safe to resume.

Continue the Lovenox injections until INR has returned to theraputic levels.

Your Cardiologist or Anti-Coagulation Manager should be consulting with the surgeon and provide the exact schedule, details, and TRAINING for 'self injection' of your Lovenox shots.

2 - Involves going in to the Hospital for a Heparin IV drip 3 to 5 days prior to the procedure, stopping 24? hours before the procedure, and resuming the IV drip once you are deemed safe not to bleed. Again, you will stay in the hospital, in the IV drip until your INR has returned to theraputic levels.

If I were undergoing surgery, I would want to be in a hospital that could tend to ANY and ALL Heart Related Conditions. I would NOT undergo surgery at a small local hospital. Just my thoughts.

Assuming you intend to proceed, please CALL your Cardiologist, tell him what is going on, and ask if he would consult with the Surgeon BEFORE you have surgery.

I would also have a frank discussion with the SURGEON about Bridging Therapy and INR just to get a 'feel' for how well he understands the issues. IF your are uncomfortable with his understanding, I would CANCEL the surgery. Again, just my (non-professional) opinion.

Best Wishes,

'AL Capshaw'

 

[Ross]

Guideline on the Management of Anticoagulation and Antiplatelet Therapy for Endoscopic Procedures

 

[ALCapshaw2]

GREAT Reference Ross!

I'll have to print it out and give a copy to my Doc's (they HATE that but...)

'AL Capshaw'

 

[Ross]

GREAT Reference Ross!

I'll have to print it out and give a copy to my Doc's (they HATE that but...)

'AL Capshaw'

I did print it out for mine, but he didn't so much as read the title much less anything it contained. I'm just happy things worked out for once, for me.

 

[Birky]

coumadin and surgery

coumadin and surgery

I am having a shoulder surgery on 11/29/06 at Loyola Medical Center in Chicago. I think Al's protocol is pretty much how they are handling by bridging. I do have to see one of their cardiologists on 11/21 so that she can do the bridging. I will be admited on 11/28 with a heperain drip and then will go on the Lovenox until I am therapeutic. My Cardiologist would not release me for surgery unless it was done this way. No outpatient surgeries.

 

[tommy]

The concept of the bridge therapy being driven by a time schedule is a mistake in my opinion. The process should be driven by the value of the INR. Regardless of when you discontinue Coumadin, start the Lovenox when the INR gets below 2.0. After the procedure, take both until the INR reaches 2.0 and then stop the Lovenox.

I respect the growing trend to be fully anti-coagulated for colonoscopies. You can adjust dosage to be near the low end of the range as a further finesse.

 

[warrenr]

inr

inr

You need to know what your inr is before stopping it for any length of time. If you are subtherapeutic say for example 1.5 you wouldn' want to stop for 5 day's. My father's inr was 1.5 when he was instructed to stop 4 full day's prior to screening colonoscopy and most of you know what the outcome was. You need to know where you are before you can get where youre going..

 

[Blanche]

Albert saw the Gastro yesterday. He is scheduled for an Endoscopy and a colonoscopy in three weeks. I was surprised when the dr. said, "Whatever you do, do not stop your Coumadin." I had prepared my self for an argument, but none was necessary. The dr. went on with a lengthly explanation of why Al needed to stay anticoagulated. He went into the safety measures he would take and also said, if any doctor told him to go off Coumadin for any procedure he should contact his internist and his cardiologist at once.
Blanche

 

[Karlynn]

It's kind of a shame that we warfarin users are surprised when the doctor says the right thing!

My best to Al for an uneventful procedure.