Hold coumadin for skin surgery?

[JimL]

I went to see a surgeon yesterday regarding a couple of bothersome cysts. He is willing to cut them out, but he wants me off coumadin as much as six days before the surgery, and then will have me on lovenox to remain anticoagulated. When I suggested that I could stay on coumadin for the surgery, and presented him with some pages from Al Lodwick?s site regarding skin surgery, he stated that these cysts are too deep. He also indicated the double danger I face: (1) not only the danger of coming off coumadin, (2) but also the danger of infection if I don?t have the cysts removed.

Any input or advice is welcome.

 

[Ross]

Jim, not ignoring this post. Waiting to see what Al or Marty might have to say. I think your in a catch 22 situation, but lets see what they may have for you.

 

[Christine]

Hi Jim.. I don't know if you're are as deep as mine were... I just had 2 dysplatic (precancerous) moles cut out.. I now have 2 one inch scars to add to my collection.. my doctor told me he was not concerned about mine because he "burns" (not correct terminology, but basicaly he does something as he cuts which minimizes bleeding considerably) - then stitched me up inside with desolvable stitches and then one long one which he removed a week later.. he only did one a day to minimize infection and only post medicated me due to my valve..

again, i don't know how big or deep.. in office or out patient.. but I was glad to know I didn't have to stop my routine if I ever had any moles cut out..

take care

christine

 

[Guest]

I think that if he has you on Lovenox at 1 mg/kg (1 mg for every 2.2 pounds that you weigh) while you are off Coumadin then you have little risk of clotting.

 

[JimL]

Thanks for your replies. I feel that I have been given poison (the valve) and I take the antidote daily. I don't really want to stop taking the antidote.

Christine, the procedure you describe sounds very similar, other than the burning. The surgeon planned on an outpatient procedure in the hospital, local anistesia, happy juice through an IV, the interior stitches, and a few exterior ones for removal a week later.

Thanks, Al, for the dosage, which will help me understand whatever they decide to do.

 

[JimL]

I've now heard from my cardiologist, who says lovenox is out, it has to be heparin which replaces coumadin for my surgery. So instead of a few hours of outpatient surgery, I now get to plan on

A WEEK'S VACATION

at my favorite local hospital. It will take roughly a week for me to be on heparin instead of coumadin so that the INR drops below 1.0, then surgery, then restart coumadin until my INR is back up.

Now, when do I have time for a week's vacation?

 

[Nancy]

Hi Jim-

I'm sorry you find yourself in this situation. Nothing is easy for you guys, is it.

Joe's been in that situation too, on a couple of occasions. Just wanted to mention, and you might not like what I'm going to say, but because Coumadin is so unpredictable, the week isn't exactly a cut and dried time frame. Better be flexible with your schedule.

I don't know how your body reacts to Coumadin, but after Joe has been off it for a while, even on Heparin, it takes forever to get it back up to therapeutic range.

I hope you don't think me a meany for bringing it up, but I'd rather you be prepared.

Best wishes.

 

[LUVMyBirman]

Hi Jim,

Sorry to hear about your 'extended vacation'.
Upside, you have a cardioligist that is up to date and looking after your best interest.

I used Lovenox 5 or 6 times for weeks on end with great sucess. Then the FDA gives the warning. Generalized in a study of pregnant women in S. Africia. Who knows if the dosing was changed as they gained weight. Or what the heck went on in that trial??

My cardio will not allow me to use Lovenox. I was to have some elective female surgery. They told me to plan on 14 days in the slammer. Well, I "elected" to deal with my issues until I can't stand it.

All the best to you. Ask them for internet access to pass the time.
PS. Here the info from the FDA if you have not seen it.
http://www.fda.gov/medwatch/SAFETY/2002/lovenox.htm
Take care and keep us posted.

 

[Guest]

There are many authorities who think that the FDA was just plain wrong in making this decision. Many are working to try to get it reversed. Please look at
http://www.warfarinfo.com/bridgetherapy.htm
and
http://www.warfarinfo.com/skin-surgery.htm
and
http://www.warfarinfo.com/procedures.htm

 

[LUVMyBirman]

I could not agree more AL. Like I mentioned......used Lovenox for a prolonged period. It either worked well or I was just plain lucky.

Please keep us posted if you hear more on the issue.

Thanks

 

[JimL]

Thanks for all the replies. I've printed out all the references you list, Al, and took two of them along to the surgeon, hoping I wouldn't have to get off coumadin at all.

People argue both sides on the South Africa pregnant women -- and my cardiologist takes one side -- but then again they did DIE, for whatever reason.

I appreciate the warning, Nancy, that I may need to plan on more than a week hospitalized. I've had these cysts, on and off, for more than ten years; they weren't always bothersome. Would that I would have had them removed before valve surgery...

Right now, my week vacation has to be after Easter and before a Wisconsin wedding -- there are a couple of weeks there. Otherwise, it will be mid summer.

 

[Rich]

Hi Jim,
Good luck on your 'vacation'.
Are you going back to Flint for this one ?
When we all get straightened out we are going to see if we can get together for that lunch we talked about.

Rich

 

[Guest]

The reason that I am unhappy with the FDA ruling against people with valves being barred from Lovenox is that there are many more articles, authored by more reputable clinicians that showed that people with valves did quite well when given Lovenox for procedures.

The FDA jumped on this like a media feeding frenzy. Now their statement could be hardly argued aginst in a court of law even when they made a bad decision.

They are saying, It may be bad but it is our decision. They won't reverse it any more than a sports referee would overturn a bad call. But this bad call is hurting all of you with valves.

 

[LUVMyBirman]

Yep, Al. I did excellent on the Lovenox. My cardio will no longer prescribe it. So......I am SOL. It's a shame for sure.

 

[JimL]

Rich, things are constantly changing, it seems. I was planning on the little hospital in Lapeer for my week's vacation. But my coumadin nurse assures me that I will be given a cardiologist there, neither of whom I want. So I may end up spending the week in McLaren in Flint because my cardiologist is there.

If Cort from Chicago is indeed making a trip to Canada, or to New York by way of Canada, he could stop by for a while. Perhaps we could gather the Michigan people available at a local restaurant in connection with Cort's trip. I have Lucky's Steak House about two blocks from my house, with Guinness on tap.

 

[Rich]

That sounds good to me Jim,
just let me know.
You have to be comfortable with the doctor and the hospital.
Maybe not as convenient but you will sleep better having the right people there.

 

[Marty]

Hold warfarin?

Hold warfarin?

Jim, I finally heard from my general-vascular surgery consultant. He would check INR prior to surgery. If 3.5 or below he would proceed to excise skin cysts without withdrawal or change in warfarin dosage. It would be done as an " in and out" same day procedure in the hospital surgicenter with no in hospital time.

 

[Blanche]

Jim:

I have to agree with Christine and Marty. Al's been on Coumadin for 12 years and in that time has had numerous cysts, moles, warts and skin tags removed. In all cases, he has remained on his Coumadin. In the past three months he's had three pre-cancerous growths removed while on Coumadin. Except for a little extra bleeding, he's had no problems whatever.

Blanche

 

[JimL]

Thanks Marty, Blanche. If I understand you correctly, I should look around for a different kind of surgeon who won't take me off coumadin for the surgery.

This guy is just a general surgeon. He's supposed to be good, but not too knowledgeable about heart valves and coumadin.

What kind of surgeon do I want to find?

But then I wouldn't get my week's vacation in the hospital...

 

[Blanche]

Jim:
Have you tried dermatologist? Most important, make sure that you are on antibiotics before and during the surgery.

Last May Al was hospitalized for internal bleeding. They ordered a colonoscopy and gave him vitamin K, which should not have been done!!! After the problem was resolved, he had to stay in hospital for 6 days on hepirin before his INR was acceptable. I stayed with him all that time and it seemed like an eternity. It was anything but a vacation. I don't recommend it. Al lost weight and came home with a cold. It took him two months to return to normal.

Best of luck in finding someone who understands anticoagulation to deal with your cyst problem.

Blanche