Help

[Regalar]

Just had sinus surgery 11 am yesterday, confused about when to restart lovenox and warfin back up. My pcp wants my to start lovenox today and my warfin 2 days from now, my sinus surgeon wants me to wait till thursday before starting anyting, after he takes out the stents in my nose for my deviated septum. right now and i am still bleeding once in awhile from my nose. Is it safe for me to stop for 4 days and take no lovenox or warfin? is safe to take the lovenox while still bleeding form the nose. i was on lovenox for 8 days before surgery.

somebody help

Ron Regalado
Aorta st jude march of 2003

 

[Ross]

Ron I'm not a Doctor but lovenox needs to be started now. I would follow your PCP's advice. Going longer then 12 hours without some type of anticoagulant in place is putting you at high risk for throwing a clot. You may have to deal with a little bleeding, but you cannot go without the lovenox. You should have your Cardiologist involved in this. He should be directing your anticoagulation therapy, not the PCP or Sinus surgeon.

You need to stay on the lovenox until your INR is in therapeutic range which will take 3 to 5 days. If it were me, I'd start my Coumadin back up tomorrow so that by Friday, it might be in range enough to stop the lovenox.

 

[Karlynn]

I agree with what Ross said on all points.

When did they have you stop your Coumadin? Did you do Lovenox bridging prior to the surgery after you stopped the Coumadin?

 

[Regalar]

thanks everybody

thanks everybody

I started the lovenox today and will start the coumadin tomorrow, just have to put up with the bleeding. i started the lovenox about 8 days before my surgery which was monday.

Ron

 

[Ross]

Ideally, you'd of stayed on Coumadin until 3 to 5 days before surgery, then as your INR dropped below acceptable levels, started the lovenox. Lovenox given up to 12 hours before surgery, then hold until 12 after surgery and begin again. Begin Coumadin after surgery and continue with both lovenox and Coumadin until your INR is again therapeutic.

 

[ALCapshaw2]

It is always wise to involve your Cardiologist (and INR manager, e.g. CRNP at a Coumadin Clinic) involved with scheduling Bridging Therapy for ANY invasive procedure, assuming they are knowledgable in anti-coagulation management.