FDA/Lovenox/spinal/warning

[lance]

This is the "black box warning" with regard to spinals and lovenox taken from a Cleveland Clinic webpage that I found Googling lovenox paralysis.

"When spinal puncture or epidural/spinal anesthesia is employed, patients anticoagulated or scheduled to be anticoagulated with low molecular weight heparins or heparinoids are at risk of developing an epidural or spinal hematoma which can result in long-term or permanent paralysis."

 

[Guest]

Typical FDA issue a warning but no suggestion as to what to do to avoid the problem.

 

[lance]

Typical FDA warning

Typical FDA warning

The black box warning referred to by the FDA=no spinal, no paralysis.

That's how I read it anyway.

 

[Guest]

But lots of my patients get epidural injections for chronic back pain. Nothing else helps.

 

[lance]

Ignorance is bliss

Ignorance is bliss

Hello

I'm beginning to understand why surgeon/cardiologist/pcp providers tell a potential user of warfarin very little if anything about this drug.

Are the patients you refer to that take spinals for pain aware of the risk they take with paralysis?

 

[Guest]

They sure are, but when you can't lay down, sit up or stand you take the chance.

 

[lance]

Taking chances

Taking chances

Were I in that much pain I'd probably take the chance too.

Are they fully anticoagulated at the time of injection.

How many have their pain resolved and not suffered any incapacity?

 

[Guest]

They are not anticoagulated at all. If they have any type on anticoagulation, they have a big risk of getting a bruise inside the spine which can leave them paralyzed for life. Some of these people are getting an injection every six weeks. Especially one man who was injured in the Korean War.

 

[Nancy]

My brother-in-law just started getting epidural injections for back pain. He had an accident many years ago and his spine was injured. In spite of 6 back operations, he's been in terrible pain and now walks with a cane. It is the only thing left for him for pain management. I hope he finally gets some relief.

He is not anticoagulated for anything.

 

[lance]

Time frame no anticoagulation

Time frame no anticoagulation

They are not anticoagulated at all. If they have any type on anticoagulation, they have a big risk of getting a bruise inside the spine which can leave them paralyzed for life. Some of these people are getting an injection every six weeks. Especially one man who was injured in the Korean War.

How many days (hours) are these patients removed from lovenox and heparin?

Has your experience with spinals include mechanical valves?

How long after a spinal do they have to wait for anti-coagulation to begin?

Korean war a long, long time ago and now they're fighting the warfarin war.

 

[Guest]

The doctor that does the most here stops them on Monday for the epidural on Saturday. He is an anesthesiologist and does them on the days that the OR is not as busy as weekdays.

I haven't really kept track of spinals with mechanical valves. The valve people tend to be younger than most epidural people, so my guess is maybe a few. I don't remember any bad outcomes - but the number must be very low. They are mostly atrial fibrillation people who have a lower risk of stroke.

They restart the warfarin the day of the epidural because it takes several days to kick in.

As a Vietnam veteran who is now suffering the effects of Agent Orange, I beginning to think that there should be a medal similar to the Purple Heart for people who were not shot in combat but suffer physical harm years later. We gave up parts of our bodies, too. The world is just not a clear as say Civil War days when you were shot or not shot.

 

[Ross]

As a Vietnam veteran who is now suffering the effects of Agent Orange, I beginning to think that there should be a medal similar to the Purple Heart for people who were not shot in combat but suffer physical harm years later. We gave up parts of our bodies, too. The world is just not a clear as say Civil War days when you were shot or not shot.

I agree with you 100% and also wish that the Government would own up to what they knew about such things as Agent Orange before exposing our troops to it. I lost a very young Uncle who was a Marine during the conflict because of that stuff.

 

[Georgia]

When I had a herniated disc the orthopedic surgeon said that spinal injections were NOT an option due to anticoagulation - he said that he wouldn't want to risk taking a mitral valve patient off warfarin.

btw: my brother died from lung cancer at age 44 - due primarily to agent orange exposure. I say "primarily" b/c he smoked; but at that time ('87) the gov't wasn't admitting that agent orange caused anything except acne, so no one was warned about the risk. I'm pretty negative about the treatment Vietnam vets got . . .

 

[lance]

Injured, surviving vets deserve "special" day

Injured, surviving vets deserve "special" day

The doctor that does the most here stops them on Monday for the epidural on Saturday. He is an anesthesiologist and does them on the days that the OR is not as busy as weekdays.

I haven't really kept track of spinals with mechanical valves. The valve people tend to be younger than most epidural people, so my guess is maybe a few. I don't remember any bad outcomes - but the number must be very low. They are mostly atrial fibrillation people who have a lower risk of stroke.

They restart the warfarin the day of the epidural because it takes several days to kick in.

As a Vietnam veteran who is now suffering the effects of Agent Orange, I beginning to think that there should be a medal similar to the Purple Heart for people who were not shot in combat but suffer physical harm years later. We gave up parts of our bodies, too. The world is just not a clear as say Civil War days when you were shot or not shot.

Vets should have a special medal and all their medical expenses paid for.