For Al - uterine ablation and warfarin

[Karlynn]

Al,
Some of us ladies have been discussing uterine ablation over on the Small Talk forum. Have you seen any protocols regarding warfarin and uterine ablation?

Both Sherry's and my gynes don't seem to think it's a procedure that would require going off warfarin and using bridge therapy but it doesn't sound as if either of them has had to deal with warfarin users having the procedure. However, one of our members did have it done, but it was a 3 day hospital stay with heparin.

I did a web search and couldn't find anything on protocol. All I did find was an article that said it was a recommended option for women suffering from extreme menses while on anticoagulation therapy. But it didn't address what is done for the procedure.

 

[Marty]

Uterine ablation is becoming more common. A co-workers wife and a daughter have just had the procedure with good results. T he purpose of the procedure is to stop bleeding. It does not cause bleeding. I am not a gyn doctor but I understand heat is used to sear and seal the endometrium. I see no reason for the patient with the mechanical mitral valve to go off Coumadin. However, any good up to date gyn specialist should be able to give a definitive answer.

 

[LUVMyBirman]

Hi Karlynn,

Main reason why I have not gone through with the proceedure. #1 lenghty hospital visit with Heparin bridge. I went through the pre-op, but did not schedule the proceedure.

Dr. Charles Miller, one of the best you can find in the field is in the area. Works out of NW Community & Edward in Naperville. He knows his stuff. High risk, etc. You may want to give him a try. If I elect to have it, he will be the man!
http://www.charlesemillermd.org/charlesemillerintro.htm
He is not just into fertility. He is a very accomplished surgeon. I would be happy to give you more personal info over the phone. Just drop me a PM

At this point, I just suffer along because of lack of time to spare.

Good luck to you.

Keep us posted.

 

[Guest]

The average of my patients is 70, so I see few who would quailfy for this procedure.

 

[Sherry]

You know, I still do not get why we would have to be bridged for this procedure. To my knowledge, there is no bloodletting involved, just the cauterization of the tissue. Gina, did he explain to you why the bridging was necessary?

 

[Karlynn]

You know, I still do not get why we would have to be bridged for this procedure. To my knowledge, there is no bloodletting involved, just the cauterization of the tissue. Gina, did he explain to you why the bridging was necessary?

I admit it confuses me too. I guess you shed the cauterized tissue and it takes about a week, much like a period. The new gyne I went to said that antibiotics would be a necessary.

I'm having a saline ultrasound done in 2 weeks to see if I have a fibroid or polyps. If I do, it sounded like I could have the ablation done in the same procedure as the removal. In that case I would definately need the bridging. And he passed his test by giving me the protocol of stopping warfarin 3 days prior, do Lovenox and start back on Lovenox and warfarin right after the procedure.

 

[LUVMyBirman]

Hi Sherry,

As I understood, the potential for bleeding and infection is there. Personally, at this point, I would rather deal with my current issues!

My MD only handles high risk patients. I do trust he knows his stuff.

 

[Sherry]

My guess, and this seems to be the opinion of my gynecologist as well, is that the risk of bleeding events is not significant enough to bridge me. I will definitely broach it again with her in two weeks. Karlynn, keep me informed on your situation, and I will do the same.

 

[Karlynn]

I will definately not be making this decision quickly (unless I have the fibroid issue and have to do the bridging thing anyway). I will also check with my cardio. She is at Northwestern Memorial in Chicago and they have a pretty well known Women's Health department there. So I imagine she can ferret out some info too.

Gina - did your doc feel there was a definate risk of major bleeding, or does he feel that, given your history, it's the safest way to go? You've mentioned him before and I gather that you trust him a lot.

I'm not at the point either that I'm at my ropes end and have to do something now. But the end results sure do sound promising.