Hold warfarin for a TEE???

[catwoman]

I will have a TEE Thursday morning (Aug. 2). My cardio's office faxed paperwork telling me to hold my warfarin the day of and the day after the procedure.

I've left a voice-mail for his secretary to clarify this. I'm hoping that it's for patients who do NOT have mechanical valves.

I'm having the TEE done because I still have perivalvular regurgitation, my cardio calls it "at the upper limit" of what is deemed acceptable. And bloodwork I had during my annual in April found that I am anemic. B-12 tablets have done nothing for it.

In the last 3-4 weeks, I have been tired. I had a recheck + echo Friday 7/27 with my cardiologist, and he's ordered a battery of tests to determine the source of the anemia. I mentioned mechanicals causing hemolysis, but he said he seldom sees hemolytic anemia in mechanical valve patients. (Online stats I saw said that 70% of mechanical valvers do have some amount of anemia. Don't know how many of those had older valves vs. newer ones, though.)

I've drawn the black bean on many things. Maybe I'm among the 3% who develop "severe" anemia.

Needless to say, I'm pretty bummed out.

Any help with info about holding warfarin for a TEE would help.

 

[Lynlw]

I'm sorry Marsha,it stinks being tired alot and frustrating trying to figure things out.You guys need a break. Heck with out even being anemic, I can imagine you would be tired from the past year.
I don't know if it is possible to change titles here, but I think you meant for a TEE
I hope they find the answer and it is something boring and easy.Lyn

 

[catwoman]

I meant TEE, not INR!!

I meant TEE, not INR!!

Lynn:

Yes, I meant a TEE. You can tell I'm tired!!!!!!!! And it's the end of the day too. And the day after a full moon.

Ross:

Can you change the title of this thread to TEE instead of INR???

 

[Blanche]

Marsha:
I have few insights into stopping anticoagulation for a TEE, but everything in me wants to yell, "don't do that." Mind you I could be wrong. Perhaps you could email our resident anticoag specialist, Al Lodwick, and get his thoughts on this. In the meantime, I wil check past posts and the net. If I find anything, I will send it immediately.

The reason I question this is that Al had a TEE and he was fully coagulated, INR=3.0 when it was done.

I know you don't want to even think about this, but, you are not positive about this, you could reschedule the test until you have more professional information.

I am so sorry this is happening to you now.

Blanche

Here's one that I found. http://www.valvereplacement.com/forums/showthread.php?t=17395&highlight=Holding+coumadin+TEE

Also, I see that Al Capshaw also had a TEE beingfully coagulated. There is also a post from Al Lodwick on the thread that I have send.

 

[Ross]

There is absolutely no reason to stop warfarin/coumadin for a TEE. NONE.

 

[ClickerTicker]

You'd need a very, very clumsy operator to need warfarin holding for a trans esophageal echocardiography.
Although I wasn't anti-coagulated at the time, I had one done - can't say it's something I'd look forward to again - but no obvious bleeding and nowhere near as uncomfortable as I had thought it would be!
Hey, all they are doing is sticking a tube down your throat - compared to some of the other things we've had done it's child's play.

Anyway, the instructions from your cardio's office make no sense - it will certainly take more than a day for your INR level to drop significantly, so what's the point of stopping it on the day of the procedure?

 

[catwoman]

Cardio clarifies orders!

Cardio clarifies orders!

Got a call back from my cardio's secretary about withholding warfarin.
She just forgot to X out that portion of the form I have to take to the hospital......................

Oh, well.

And I did try to get the blood drawn today. But the woman at Lab Corp couldn't read my cardio's secretary's handwriting. Or should I say, her abbreviations. Couldn't read iron binding ca. (it actually looks like IROIV BINDING CA). When I explained it was an iron binding test, she said, "Well, it looks like we're being told to do a cancer test," because of the CA following IRON BINDING.

So....... I try again Tuesday for:

iron test
iron binding capacity
B-12
folid acid
sed rate
haptoglobulin
retic count
basic metabolic panel
CBC with diff w plt (guess that means PLaTelets??)
Plus 3 blood cultures 10 minutes apart.

I've had blood cultures about 3 times before. Guess that's SOP to CYA???

I'm hoping there's a magic wand out there.....

 

[Lynlw]

Got a call back from my cardio's secretary about withholding warfarin.
She just forgot to X out that portion of the form I have to take to the hospital......................

Oh, well.

And I did try to get the blood drawn today. But the woman at Lab Corp couldn't read my cardio's secretary's handwriting. Or should I say, her abbreviations. Couldn't read iron binding ca. (it actually looks like IROIV BINDING CA). When I explained it was an iron binding test, she said, "Well, it looks like we're being told to do a cancer test," because of the CA following IRON BINDING.

So....... I try again Tuesday for:

iron test
iron binding capacity
B-12
folid acid
sed rate
haptoglobulin
retic count
basic metabolic panel
CBC with diff w plt (guess that means PLaTelets??)
Plus 3 blood cultures 10 minutes apart.

I've had blood cultures about 3 times before. Guess that's SOP to CYA???

I'm hoping there's a magic wand out there.....

I'm glad you got that part straightend out.You know you should suggest they have seperate forms instead of just X out that section.that could be dangerous for patients not as knowledgeble as you.
Yes you're right platelets. That looks like a good list of test to rule out things and narrow down why you are so tired. Hopefully they can figure out the anemia.Good Luck with everything.Lyn

 

[ALCapshaw2]

I had a TEE at my local Hospital this Spring.

NO HOLD on Coumadin (i.e. it was done fully anti-coagulated).

I asked about pre-med and was told to skip it because the Cardiologist wanted to use an IV antibiotic (gentomycin sp? I think).

Since it was in the outpatient procedure area, a Nurse anesthesiologist was available and they used some short / fast acting anesthesia along with only 2 mg of Versed. I came to quickly afterwards with NO undesirable side effects. It was a GOOD experience.

Good Luck getting all your tests straightened out!

Sadly, patients MUST be VIGILENT these days!

'AL Capshaw'

 

[bvdr]

Marsha, I hope they figure something out for you soon and that it is an easy fix. I know you keep up a busy schedule and have gone through a lot this year and have reason to feel worn out but when you are anemic you still feel tired after you rest and that is no good. I'm interested in that paravalvular leak too. I hope that isn't the problem but if it is you know we are here for you.

 

[Bina]

Marsha, good thing you checked your paperwork.
I am always catching little "glitches" on doc orders/scripts, etc.
It's kind of unnerving.....
Best wishes.

 

[catwoman]

I feel much better this morning. Got 8 hours sleep + took an extra strength Tylenol PM last night.

BTW, got a very interesting letter yesterday from a woman who bought an Abyssinian from me 8 years ago. See post under Small Talk. (I can't determine where it's most appropriate.)

 

[geebee]

Marsha,

Hope all goes well and they determine what is happening.

 

[Sherry]

Marsha, I've had two since my surgery, and neither cardio even mentioned holding doses. I was somewhere around 2.5 when I had my last one. Best of luck to you.

 

[jeffp]

There is absolutely no reason to stop warfarin/coumadin for a TEE. NONE.

What if they plan on being REALLY rough with it?

 

[Ross]

What if they plan on being REALLY rough with it?

I don't think they could get any rougher then they were with me and I didn't have any major problems. I did bleed a little bit.

Actually, I think it would be more of a concern to the stomach, since your wretching so badly when they first introduce the probe.

 

[catwoman]

I'm not looking forward to the TEE because:

I barf -- not vomit -- at the drop of a hat. Just smells can set me off. No stomach pain, just instant barfing.
And whenever I get my teeth cleaned, I'm constantly fighting the urge to gag.

 

[Ross]

I'm not looking forward to the TEE because:

I barf -- not vomit -- at the drop of a hat. Just smells can set me off. No stomach pain, just instant barfing.
And whenever I get my teeth cleaned, I'm constantly fighting the urge to gag.

You'll only remember gagging for a few seconds, then you'll remember nothing until your done.