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RandyL
Anybody ever get one of these shots while on Coumadin? Should I stop my coumadin? and if so how long before the shot day and when do I resume my Coumadin?
Thanks
Thanks
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DrAllan
I cannot predict the future. The risk of any procedure is bleeding. If you were to develop bleeding in the epidural space, then you would have numbness and paralysis of the lower extremities on an emergency basis. This would require emergency opening of your spinal column via a ?laminectomy? with reversal of anticoagulation and the giving of clotting factors to prevent complications during the surgery. I have absolutely no idea of the percentage risk of this occurring. Please realize that bridging therapy while effective is not absolutely a way of making the procedure safe for you. Those of us on Coumadin walk a fine line of risk and benefit.
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RandyL
well I have some problems with my L3 and L4 which is labeled as stenosis(go figure, I am getting pretty sick of that word). My cardio approved this and said I needed to be off coumadin 5 days before the procedure. This does not sound correct to me. The reason I am having the procedure is because both my thighs stay numb 24/7 and also at night they pinch and burn. This problem I believe was aggravated from laying in bed on my back for 3 weeks in the hospital after OHS. I tried the oral steroids which worked a little bit but now the pain is back. I really don't know what to do at this point. Hoping you' all would have some advice.
Lovenox injections and spinals
Lovenox injections and spinals
Hello RandyL
Several months ago I needed surgery. Warfarin was stopped and Lovenox injections were given every twelve hours. Lovenox is supposed to clear your system in twelve hours so theoretically twelve hours following the last injection the evening before the surgery there would be no anticoagulation in my system. Doctors wanted to use a spinal. I have never had anything injected into my spine and wasn't about to start so I insisted on a general anesthesia.
Anticoagulation clinic approved of the spinal and the 12 hour withdrawal period. It is a dicey situation and complications should they occur could be devastating.
I think I remember a post by Al Lodwick about patients in chronic pain using spinals successfully.
It really is a tough decision.
Lovenox injections and spinals
Hello RandyL
Several months ago I needed surgery. Warfarin was stopped and Lovenox injections were given every twelve hours. Lovenox is supposed to clear your system in twelve hours so theoretically twelve hours following the last injection the evening before the surgery there would be no anticoagulation in my system. Doctors wanted to use a spinal. I have never had anything injected into my spine and wasn't about to start so I insisted on a general anesthesia.
Anticoagulation clinic approved of the spinal and the 12 hour withdrawal period. It is a dicey situation and complications should they occur could be devastating.
I think I remember a post by Al Lodwick about patients in chronic pain using spinals successfully.
It really is a tough decision.
G
geebee
Randy,
Can't help much about the injection info but I sure hope you cardio did not suggest going off coumadin for 5 days without bridging. If he did - what the h**l was he thinking? You could end up with a lot more numb than what you have now.
Talk to him about bridging and/or what your INR should be for the procedure. Maybe you can get by with reducing it somewhat. Certainly safer than discontinuing ACT altogether.
Can't help much about the injection info but I sure hope you cardio did not suggest going off coumadin for 5 days without bridging. If he did - what the h**l was he thinking? You could end up with a lot more numb than what you have now.
Talk to him about bridging and/or what your INR should be for the procedure. Maybe you can get by with reducing it somewhat. Certainly safer than discontinuing ACT altogether.
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RandyL
Well the clinic called me today and said my Doctor faxed over instructions to totally stop my coumadin 5 days before the procedure. That was the only instructions
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Mary
Someone posted about the danger of even the slightest drop of blood during an epidural several months ago. Actually, I looked back and the discussion was started by Lance. Here's the thread:http://www.valvereplacement.com/forums/showthread.php?p=149025#post149025
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RandyL
Well from what I have read, it seems the best chance of no complications is to be totally off the coumadin or any other anti-coalulation drug. I guess this is obviously dangerous for the risk of stroke or heart attack but less risky than having a drop of blood in your spine which can paralyze you.I need some advice on what the rest of you would do if in the same situation.
Thanks
Thanks
I don't have any advice but wanted to say i'm sorry you are having back problems on top of everything else. I have problems w/ L4L5s1 so know the pain you are in. (i actually have a spinal stimulator implanted.) I hope just 1 shot will help, and you won't need more. I'll keep you in my prayers, that the docs figure out what is safest and you get some relief from your pain, Lyn
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Guest
It is a game of chance. If you have a stroke because the warfarin was stopped for 5 days what would be the benefit. If you don't have a stroke the epidural will probably last a month or two and you will need another one. Using a bridge with Lovenox is only slightly less dangerous. The FDA requires a black box warning on these products with epidurals. This is their strongest warning.
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RandyL
allodwick said:
Gees Al. Are you telling me it is a waste of time to get the epidural and way to risky to go off the coumadin for 5 days? I thought you said you have a lot of patients that have done this and there have been no problems that you know of. I don't know what to do now, go ahead with my appointment or cancel.
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Guest
You can argue both ways. What I thought the tone of your post was that one shot might be a cure. I have seen quite a few people who get them but many are lower risk than mechanical valves.
I don't take a stand one way or the other with my patients, I just want to make sure that people are aware of both sides of the issue.
I don't take a stand one way or the other with my patients, I just want to make sure that people are aware of both sides of the issue.
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DrAllan
Al,
I too am confused when you refer to relative risk, i.e. "lower risk than mechanical valves". Yes, there are relative risks related to emboli from different valve positions and types, but in this case therisk s from the possible bleeding into the epidural space which is strictly relted to the coumadin and by implication the INR. I'm not sure that clinical risk of surgically induced bleeding varies when the INR ranges over the spectrum of 2.5-4.5. What clinically is unique about your group of patients that have epidural injections and their particular risk factors?
I too am confused when you refer to relative risk, i.e. "lower risk than mechanical valves". Yes, there are relative risks related to emboli from different valve positions and types, but in this case therisk s from the possible bleeding into the epidural space which is strictly relted to the coumadin and by implication the INR. I'm not sure that clinical risk of surgically induced bleeding varies when the INR ranges over the spectrum of 2.5-4.5. What clinically is unique about your group of patients that have epidural injections and their particular risk factors?
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Guest
I meant people who take warfarin for atrial fibrillation who have a fairly low risk of having a stroke on any given day that they are off warfarin as opposed to people with mechanical valves. In my clinic we see anyone who takes warfarin for any reason. I probably see about 300 people with atrial fibrillation as opposed to about 90 people with mechanical valves.
A few months ago I had a cervical epidural. I was required to be off coumadin for 5 days and had a protime drawn just before the procedure to verify that my INR was close to 1. It concerned me and I was not bridged with Lovenox but restarted my coumadin after about 12 hours post procedure and also began Lovenox until I was back in range. My PCP said next time (if there is one) he wants me in the hospital on heparin with only the briefest period of being undercoagulated as possible.
I had several lumbar epidurals years ago before I had back surgery. For me they only temporarily postponed surgery but they did provide periods of relief.
The cervical epidural didn't seem to do much initially but within about 10 days to 2 weeks the pain was notedly less. Now however it is again about what it was before the epidural.
Sometimes epidurals are diagnostic as well as providing pain relief. The response to one helps determine what further treatment may be indicated. I hope all goes well for you and this is soon behind you.
I had several lumbar epidurals years ago before I had back surgery. For me they only temporarily postponed surgery but they did provide periods of relief.
The cervical epidural didn't seem to do much initially but within about 10 days to 2 weeks the pain was notedly less. Now however it is again about what it was before the epidural.
Sometimes epidurals are diagnostic as well as providing pain relief. The response to one helps determine what further treatment may be indicated. I hope all goes well for you and this is soon behind you.
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RandyL
anybody else? haven't seen Ross chime in here yet.
Marty
Well-known member
RandyL said:
Don't know whether this helps but for two years my wife had severe back and leg pains, finally saw a spine neurosurgeon and diagnosed with spondylolithesis
at L-3,L-4. MRI showed spinal stenosis at that level. Treatments offered included PT, epidural injections, or decompression fusion spinal surgery. She found that PT really does nothing for her condition, epidural gives only temporary relief, so she chose the big time surgery laminectomy then fusion with pedicle screws and longitudinal rods plus cadaver bone chips, etc. She's now four months out and a changed person. Feels great. No pain at all! We are headed for Rehoboth Beach tomorrow and the boardwalk.
My wife is not on anticoagulants. For someone who is I would recommend hospitalization, with heparin bridging. This surgeryn is not very bloody and all should go well
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RandyL
Marty thanks alot but I am not ready to under go the knife again so soon after my OHS, matter a fact I don't even want to set foot in a hospital for a long time.lol
