I think my GI will want a colonoscopy...anyone with experience want to weigh in?

[COLLEEN S]

Hi,
I looked up the archives on colonoscopies while on warfarin and found the posts that said "bridging" with lovenox and going off warfarin for 3 days is no longer neccessary for a screening colonoscopy.
My question is, what if your cardio (whom I saw the other day for a checkup) insists on it and the GI doesnt? My cardio said she will be in charge of the warfarin management. I havent seen the GI yet. This is all due to abdominal pain I have been having for a few months off and on.
Who out there can tell me what they did with their warfarin before the procedure? Thanks in advance.

 

[Ross]

Insist on staying on Coumadin and finding someone who will do you anticoagulated. There is no reason to come off of Coumadin for a simple colonscopy. If large polyps are found, they can have a do over later without anticoagulation, but if they are just small polyps, no reason to come off.

 

[catwoman]

Colleen:

Search the archives in the Anti-Coagulation forum for posts by warrenr. His dad died (not sure when, maybe 18-24 months???) after stroking the same day he had a colonoscopy. He was a mitral valver, went off warfarin. Seems his ACT hadn't been managed very well. I think Warren wanted to bring legal action over this but don't know if he did. I do know there were several depositions taken, and he may have posted the results of those here.

I had a c-scope last Dec. 1 and I refused to come off warfarin. I told my GI doc that I would drop my INR to 2.5, and he agreed to that.

 

[Blanche]

It's too risky...

It's too risky...

Colleen:
I echo..you must not go off anticoagulation for a Colonoscopy. My husband (mechanical mitral valve 10/1990) has had at least four colonoscopies while being fully anticoagulated. I have atrial fib and take Coumadin too. I have had two colonoscopies while fully anticoagulated and am planning on one more in April.

Blanche

 

[Cris N]

Hi,

My question is, what if your cardio (whom I saw the other day for a checkup) insists on it and the GI doesnt? My cardio said she will be in charge of the warfarin management. I havent seen the GI yet.

Who's going to do the procedure? I seriously doubt that the cardio is going to do it, so it's really between you and the GI, isn't it.

My GI was wanted me at 2.0 because I was having a hemorrhoidectomy at the same time. My PCP had me on Lovenox before & after since he was afraid I might drop too low.

 

[Rich]

Colleen,
I pretty much agree with the others, do not come off Coumadin for this.
Due to some problems I had my third one over the last five years just this past week. My cardio and my GI do agree on a three day hold but this is where I set my own rules. My GI wants my INR around 2.0 or a little above and I agreed to that. First off I don't stop it in terms of days, I back up 72 hours from the time of the procedure, and that is when I take my last dose.
Depending on the time you stop and the time of the procedure, it could be more like four days and that is not acceptable to me.
Secondly I go to the lab for a blood draw the day before the test. Depending on my INR I make an adjustment if neccessary.I do this because what if your INR already was on the low side when you started the three day hold. Way too dangerous!
At both the first and third tests polyps were removed, and I never had any bleeding problems nor anything else.
So please protect yourself and good luck with the test, I know it's no fun.
Rich

 

[MarkU]

I've had three colonscopies in the past five years and did a Lovenox bridge each time.

The GI who did my first one insisted that I go off my Coumadin completely, while my Cardiologist, who ironically was in the same medical practice group, said no way.

I got caught in the middle of the two doctors. My cardiologist tried calling the GI, but he wouldn't return his phone calls. In the end my cardiologist (who I trust completely) just said to do the bridge and don't tell the GI.

The GI got ticked off at me after the procedure when he saw the bruising on my stomach from my Lovenox injections. He tried to give me a rough time, but I just told him to take it to my cardiologist if he had a problem with it.

I ended up changing GI's shortly after. I ended up with a guy who agreed that I'd be crazy to go off Coumadin completely and recommended always doing the Lovenox.

I also found out after the fact that the first GI doc had a history of botched polypectomies and perforated colons and his insurance carrier had settled a dozen or so malpractice claims out of court. That might part of the reason he was insisting that I go off the Coumadin completely.

Mark

 

[starrman]

I just had my first one two months ago. My cardio told me that some GIs do it with it and some do not and the decision is the GI's since they are the one performing the procedure.

My GI doctor said to let me on the coumadin but did tell me if they found something signifiacnt, they would hold fixing it for another time. Fortunately, they found a small polyp on a thicker part of the colon and were able to take it out without incident.

Hope that helps.- Jim

 

[Gail in Ca]

My terrific cardio insisted I go off coumadin and bridge to lovenox before my 1st colonoscopy. All went well, but it took a long time to get my inr back up into range. My poor abdomen was so bruised! Thankfully, nothing was found so I don't need another for 10 yrs!!

 

[catwoman]

I have an appt with my cardio this afternoon (6-month checkup). Am taking a list of questions. Will put how he prefers anticoagulated patients handled for colonoscopies.

The cardio I went to in Dallas was adamant about not going off warfarin for colonoscopies since my valve is in the mitral position.

 

[catwoman]

At my appointment today, my cardiologist said absolutely no to coming off warfarin for a colonoscopy. He said that invites lawsuits.

He said that I would continue warfarin for a colonoscopy; if something were found, I could bridge for a 2nd scope, stay on warfarin at a lower dose or go to heparin.

I had a colonoscopy last Dec. 1, so I'm good for several more years, thank heavens.

 

[bvdr]

I'm going to try to find the link for the official "guidelines". I showed it to my GI and she agreed. I had my colonoscopy without coming off warfarin with no problems.

My link didn't work so I'll have to search to find one that does. I'll insert it when I find it.

http://www.med.umich.edu/cvc/services/site_anticoag/Endoscopic procedures.pdf

 

[Sherry]

I just recently posted this on the endoscopy thread, but I just recently went through both a few months ago, and my cardio said "no coming off Coumadin", and the reluctant GI said he would do it. He did stress that he wouldn't cut off any large polyps with me on, but it was a moot point in that there was nothing there anyway. Both went fine, and I had the piece of mind that I didn't have to come off the drug. It's possible, and as others have suggested here, the cardio needs to communicate with the GI. If one GI says no, find one who will work with you. There are plenty out there.

 

[COLLEEN S]

Thanks to all who responded. My results are NORMAL for the colonoscopy. They found a cyst on my liver that I already knew was there. For the pulmonary function test, my results are obstructive asthma. I am now on inhalers. Haven't been on in a while. Thanks to all who were concerned.

 

[Ross]

Got a copy of your PFT? I'd like to compare it to mine!

 

[COLLEEN S]

No unfortunately, Ross, I don't. I would like a copy.